Provider Demographics
NPI:1972128213
Name:MARTINEZ FERRER, JOSUE YADIR
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:YADIR
Last Name:MARTINEZ FERRER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8365 SW 152ND AVE APT C-115
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-4028
Mailing Address - Country:US
Mailing Address - Phone:786-366-1234
Mailing Address - Fax:
Practice Address - Street 1:8365 SW 152ND AVE APT C-115
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-4028
Practice Address - Country:US
Practice Address - Phone:786-366-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-117896106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician