Provider Demographics
NPI:1720656416
Name:MARTINEZ VALLINA, ISRAEL MANUEL
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:MANUEL
Last Name:MARTINEZ VALLINA
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 1:6800 NW 179TH ST APT 306
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-7431
Mailing Address - Country:US
Mailing Address - Phone:386-315-9263
Mailing Address - Fax:
Practice Address - Street 1:6800 NW 179TH ST APT 306
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-7431
Practice Address - Country:US
Practice Address - Phone:386-315-9263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-139897106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician