Provider Demographics
NPI:1851160055
Name:MARTINEZ DE LA PORTILLA, MARIEN KARLA (RBT)
Entity Type:Individual
Prefix:
First Name:MARIEN
Middle Name:KARLA
Last Name:MARTINEZ DE LA PORTILLA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13880 SW 64TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1183
Mailing Address - Country:US
Mailing Address - Phone:863-614-6341
Mailing Address - Fax:
Practice Address - Street 1:13880 SW 64TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1183
Practice Address - Country:US
Practice Address - Phone:863-614-6341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-318675106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician