Provider Demographics
NPI:1487019063
Name:MARTINEZ, ALEXIS JOSE (BCBA)
Entity Type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:JOSE
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:BCBA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11159 NW 39TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7573
Mailing Address - Country:US
Mailing Address - Phone:786-612-5077
Mailing Address - Fax:305-402-5754
Practice Address - Street 1:11159 NW 39TH ST APT 201
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7573
Practice Address - Country:US
Practice Address - Phone:786-612-5077
Practice Address - Fax:305-402-5754
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst