Provider Demographics
NPI:1417566787
Name:MARTIN OSORIA, MAIKEL
Entity Type:Individual
Prefix:
First Name:MAIKEL
Middle Name:
Last Name:MARTIN OSORIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6234 SW 151ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2739
Mailing Address - Country:US
Mailing Address - Phone:305-744-1711
Mailing Address - Fax:
Practice Address - Street 1:6234 SW 151ST CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2739
Practice Address - Country:US
Practice Address - Phone:305-744-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-116641106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician