Provider Demographics
NPI:1598114787
Name:NEGRIN MARTINEZ, MARIO (BEHAVIOR ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:NEGRIN MARTINEZ
Suffix:
Gender:M
Credentials:BEHAVIOR ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11678 NW 1ST LN APT 6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4911
Mailing Address - Country:US
Mailing Address - Phone:786-587-3582
Mailing Address - Fax:
Practice Address - Street 1:315 NW 109TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5250
Practice Address - Country:US
Practice Address - Phone:786-587-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician