Provider Demographics
NPI:1619606993
Name:MARTINEZ, WENDY AMARILIS
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:AMARILIS
Last Name: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 1:15300 SW 284TH ST APT 22
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1380
Mailing Address - Country:US
Mailing Address - Phone:786-222-2356
Mailing Address - Fax:
Practice Address - Street 1:15300 SW 284TH ST APT 22
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1380
Practice Address - Country:US
Practice Address - Phone:786-222-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician