Provider Demographics
NPI:1780421768
Name:MARTINEZ ZAYAS, MARIA DE LOURDES
Entity type:Individual
Prefix:
First Name:MARIA DE LOURDES
Middle Name:
Last Name:MARTINEZ ZAYAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:L
Other - Last Name:MARTINEZ ZAYAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12760 WESTWOOD LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2345
Mailing Address - Country:US
Mailing Address - Phone:813-814-5971
Mailing Address - Fax:
Practice Address - Street 1:13200 MCCORMICK DR STE E-1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3010
Practice Address - Country:US
Practice Address - Phone:813-814-5971
Practice Address - Fax:813-814-5972
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist