Provider Demographics
NPI:1629732565
Name:CANIZARES MARTINEZ, MISLEIDY
Entity Type:Individual
Prefix:
First Name:MISLEIDY
Middle Name:
Last Name:CANIZARES 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 1:2719 NW 7TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-7016
Mailing Address - Country:US
Mailing Address - Phone:786-670-0010
Mailing Address - Fax:
Practice Address - Street 1:2719 NW 7TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-7016
Practice Address - Country:US
Practice Address - Phone:786-670-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-21-151754106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician