Provider Demographics
NPI:1376331546
Name:MARTINEZ MEJIAS, ELICEO
Entity type:Individual
Prefix:
First Name:ELICEO
Middle Name:
Last Name:MARTINEZ MEJIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 NW 171ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4256
Mailing Address - Country:US
Mailing Address - Phone:561-371-2328
Mailing Address - Fax:
Practice Address - Street 1:3271 NW 171ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4256
Practice Address - Country:US
Practice Address - Phone:561-371-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-429804106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician