Provider Demographics
NPI:1295487874
Name:MARTINEZ LUIS, DARAMY
Entity type:Individual
Prefix:
First Name:DARAMY
Middle Name:
Last Name:MARTINEZ LUIS
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 1:885 E 1ST AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4171
Mailing Address - Country:US
Mailing Address - Phone:305-570-7615
Mailing Address - Fax:
Practice Address - Street 1:885 E 1ST AVE APT 106
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4171
Practice Address - Country:US
Practice Address - Phone:305-570-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-53587103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty