Provider Demographics
NPI:1245069822
Name:MARTINEZ HERNANDEZ, ADISLIET
Entity type:Individual
Prefix:
First Name:ADISLIET
Middle Name:
Last Name:MARTINEZ HERNANDEZ
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 1:777 NW 72ND AVE STE 1083
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3176
Mailing Address - Country:US
Mailing Address - Phone:305-342-7643
Mailing Address - Fax:
Practice Address - Street 1:10500 SW 8TH ST APT 404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2637
Practice Address - Country:US
Practice Address - Phone:786-690-8906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician