Provider Demographics
NPI:1558139048
Name:MARTINEZ ARIAS, JESSICA FERNANDA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FERNANDA
Last Name:MARTINEZ ARIAS
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 1:15472 HARRISON DR
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2530
Mailing Address - Country:US
Mailing Address - Phone:786-829-8797
Mailing Address - Fax:
Practice Address - Street 1:15472 HARRISON DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2530
Practice Address - Country:US
Practice Address - Phone:786-829-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23316058106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician