Provider Demographics
NPI:1790573426
Name:MARTINEZ, ANNIA CECILIA
Entity type:Individual
Prefix:
First Name:ANNIA
Middle Name:CECILIA
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 NW 103RD ST APT 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4672
Mailing Address - Country:US
Mailing Address - Phone:786-315-7552
Mailing Address - Fax:
Practice Address - Street 1:8414 NW 103RD ST APT 105
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-4672
Practice Address - Country:US
Practice Address - Phone:786-315-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician