Provider Demographics
NPI:1609301464
Name:IGLESIAS MARTINEZ, KATHERIN
Entity Type:Individual
Prefix:
First Name:KATHERIN
Middle Name:
Last Name:IGLESIAS 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 1:1046 SOLAR RD
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-9830
Mailing Address - Country:US
Mailing Address - Phone:305-926-4722
Mailing Address - Fax:
Practice Address - Street 1:1046 SOLAR RD
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-9830
Practice Address - Country:US
Practice Address - Phone:305-926-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician