Provider Demographics
NPI:1003621277
Name:OTERO CEBALLOS, MARTA
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:OTERO CEBALLOS
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 1:6621 MAIN ST APT 2311
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2273
Mailing Address - Country:US
Mailing Address - Phone:786-957-9636
Mailing Address - Fax:
Practice Address - Street 1:6621 MAIN ST APT 2311
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2273
Practice Address - Country:US
Practice Address - Phone:786-957-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician