Provider Demographics
NPI:1750652145
Name:MARTINEZ, MAYDA (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MAYDA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 SE 25TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-2175
Mailing Address - Country:US
Mailing Address - Phone:786-352-1568
Mailing Address - Fax:
Practice Address - Street 1:1495 SE 25TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-2175
Practice Address - Country:US
Practice Address - Phone:786-352-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No332H00000XSuppliersEyewear Supplier