Provider Demographics
NPI:1659132710
Name:ANEL MARTINEZ, ISABEL PATRICIA
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:PATRICIA
Last Name:ANEL 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 1:9602 KINGSBURGH CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1933
Mailing Address - Country:US
Mailing Address - Phone:813-410-0967
Mailing Address - Fax:
Practice Address - Street 1:9602 KINGSBURGH CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1933
Practice Address - Country:US
Practice Address - Phone:813-410-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-320128106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician