Provider Demographics
NPI:1558957217
Name:MARTINEZ CHANG, MAILEI AMPARO
Entity Type:Individual
Prefix:
First Name:MAILEI
Middle Name:AMPARO
Last Name:MARTINEZ CHANG
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 1:9971 SW 223RD TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1552
Mailing Address - Country:US
Mailing Address - Phone:786-370-1630
Mailing Address - Fax:
Practice Address - Street 1:9971 SW 223RD TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1552
Practice Address - Country:US
Practice Address - Phone:786-370-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator