Provider Demographics
NPI:1134913056
Name:LEON MARTINEZ, IRINA
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:LEON MARTINEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 W CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5912
Mailing Address - Country:US
Mailing Address - Phone:813-775-5482
Mailing Address - Fax:
Practice Address - Street 1:3217 W CLIFTON ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5912
Practice Address - Country:US
Practice Address - Phone:813-775-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25-418874106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician