Provider Demographics
NPI:1457125775
Name:MESA MARTINEZ, LIZBETTY
Entity Type:Individual
Prefix:
First Name:LIZBETTY
Middle Name:
Last Name:MESA MARTINEZ
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 1:18921 NW 39TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2725
Mailing Address - Country:US
Mailing Address - Phone:786-630-0002
Mailing Address - Fax:
Practice Address - Street 1:18921 NW 39TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2725
Practice Address - Country:US
Practice Address - Phone:786-630-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician