Provider Demographics
NPI:1790461747
Name:MARTINEZ ALBA, IRIDIS
Entity Type:Individual
Prefix:
First Name:IRIDIS
Middle Name:
Last Name:MARTINEZ ALBA
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 1:39 SW 76TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2427
Mailing Address - Country:US
Mailing Address - Phone:786-443-4421
Mailing Address - Fax:
Practice Address - Street 1:39 SW 76TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2427
Practice Address - Country:US
Practice Address - Phone:786-443-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician