Provider Demographics
NPI:1578196879
Name:TELLECHEA MARTINEZ, DANIELA AYLIMER
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:AYLIMER
Last Name:TELLECHEA MARTINEZ
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 1:1579 CORAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5429
Mailing Address - Country:US
Mailing Address - Phone:954-496-6075
Mailing Address - Fax:
Practice Address - Street 1:1579 CORAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5429
Practice Address - Country:US
Practice Address - Phone:954-496-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20111244106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician