Provider Demographics
NPI:1821892977
Name:SANTIESTEBAN MARTINEZ, MARISOL BEATRIZ
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:BEATRIZ
Last Name:SANTIESTEBAN 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 1:2935 NE 163RD ST APT 2Q
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4451
Mailing Address - Country:US
Mailing Address - Phone:954-871-9724
Mailing Address - Fax:
Practice Address - Street 1:2898 NW 79TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1033
Practice Address - Country:US
Practice Address - Phone:305-597-3861
Practice Address - Fax:305-597-3861
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-419999106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician