Provider Demographics
NPI:1821863002
Name:NAGUATE MARTINEZ, YOMARIS
Entity Type:Individual
Prefix:
First Name:YOMARIS
Middle Name:
Last Name:NAGUATE 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 1:2007 S 58TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5309
Mailing Address - Country:US
Mailing Address - Phone:813-669-1094
Mailing Address - Fax:
Practice Address - Street 1:2007 S 58TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5309
Practice Address - Country:US
Practice Address - Phone:813-669-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-310225106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician