Provider Demographics
NPI:1629591912
Name:MARTINEZ PEDRERA, GISSELLE MARIA
Entity Type:Individual
Prefix:
First Name:GISSELLE
Middle Name:MARIA
Last Name:MARTINEZ PEDRERA
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 1:10260 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1711
Mailing Address - Country:US
Mailing Address - Phone:786-592-2263
Mailing Address - Fax:
Practice Address - Street 1:9031 SW 122ND AVE APT 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2015
Practice Address - Country:US
Practice Address - Phone:786-592-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-42781103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst