Provider Demographics
NPI:1841863313
Name:CALZADA-MARTINEZ, KATERINE
Entity type:Individual
Prefix:
First Name:KATERINE
Middle Name:
Last Name:CALZADA-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 1:4245 NW 170TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4430
Mailing Address - Country:US
Mailing Address - Phone:754-207-7495
Mailing Address - Fax:
Practice Address - Street 1:4245 NW 170TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4430
Practice Address - Country:US
Practice Address - Phone:754-207-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-150676106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician