Provider Demographics
NPI:1134888456
Name:GIL MARTINEZ, MARIALYS
Entity type:Individual
Prefix:
First Name:MARIALYS
Middle Name:
Last Name:GIL 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 1:20 SW 108TH AVE APT F4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1436
Mailing Address - Country:US
Mailing Address - Phone:786-560-7521
Mailing Address - Fax:
Practice Address - Street 1:20 SW 108TH AVE
Practice Address - Street 2:APT F4
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1436
Practice Address - Country:US
Practice Address - Phone:754-235-2701
Practice Address - Fax:786-432-1806
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21188154106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty