Provider Demographics
NPI:1972254340
Name:MARTINEZ SARRIA, MATILDE
Entity Type:Individual
Prefix:
First Name:MATILDE
Middle Name:
Last Name:MARTINEZ SARRIA
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 1:5275 NW 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-8829
Mailing Address - Country:US
Mailing Address - Phone:727-608-9624
Mailing Address - Fax:
Practice Address - Street 1:5275 NW 29TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-8829
Practice Address - Country:US
Practice Address - Phone:727-608-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCABA-0-21-12376106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst