Provider Demographics
NPI:1417437302
Name:ARRASCAETA MARTINEZ, GRETELL
Entity Type:Individual
Prefix:
First Name:GRETELL
Middle Name:
Last Name:ARRASCAETA 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 1:10360 SW 212 STREET
Mailing Address - Street 2:APT 103
Mailing Address - City:HOMEFSTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3088
Mailing Address - Country:US
Mailing Address - Phone:786-564-3823
Mailing Address - Fax:305-248-3499
Practice Address - Street 1:654 NE 9TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4934
Practice Address - Country:US
Practice Address - Phone:305-248-3488
Practice Address - Fax:305-248-3499
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022803800Medicaid