Provider Demographics
NPI:1407619521
Name:TOLEDO MARTINEZ, BLANCA NELY
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:NELY
Last Name:TOLEDO MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 W 29TH ST LOT A11
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5553
Mailing Address - Country:US
Mailing Address - Phone:786-281-1219
Mailing Address - Fax:
Practice Address - Street 1:12490 NE 7TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5660
Practice Address - Country:US
Practice Address - Phone:786-709-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty