Provider Demographics
NPI:1265102719
Name:MARTINEZ PILOTOS, YIRKA
Entity type:Individual
Prefix:
First Name:YIRKA
Middle Name:
Last Name:MARTINEZ PILOTOS
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 1:5505 NW 7TH ST APT W402
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3208
Mailing Address - Country:US
Mailing Address - Phone:954-505-1071
Mailing Address - Fax:
Practice Address - Street 1:5505 NW 7TH ST APT W402
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3208
Practice Address - Country:US
Practice Address - Phone:954-505-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-24-73718103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108869400Medicaid