Provider Demographics
NPI:1801401286
Name:MARTIN MARTINEZ, NAYLA
Entity Type:Individual
Prefix:
First Name:NAYLA
Middle Name:
Last Name:MARTIN 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 1:7477 SW 82ND ST APT C118
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7360
Mailing Address - Country:US
Mailing Address - Phone:786-630-4610
Mailing Address - Fax:
Practice Address - Street 1:7477 SW 82ND ST APT C118
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7360
Practice Address - Country:US
Practice Address - Phone:786-630-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-128566106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician