Provider Demographics
NPI:1497762710
Name:MARTINEZ, ISILDA RUIZ (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ISILDA
Middle Name:RUIZ
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 COLLINS AVE
Mailing Address - Street 2:#804
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4722
Mailing Address - Country:US
Mailing Address - Phone:305-803-1853
Mailing Address - Fax:305-538-6567
Practice Address - Street 1:960 ARTHUR GODFREY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3326
Practice Address - Country:US
Practice Address - Phone:305-803-1853
Practice Address - Fax:305-538-6567
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6659103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1052AMedicare ID - Type Unspecified