Provider Demographics
NPI:1639838477
Name:MARTINEZ, JULIA ANDREA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANDREA
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 1:41 SE 5TH ST APT 917
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2538
Mailing Address - Country:US
Mailing Address - Phone:786-606-5122
Mailing Address - Fax:
Practice Address - Street 1:7800 S RED RD STE 216
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5523
Practice Address - Country:US
Practice Address - Phone:305-662-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health