Provider Demographics
NPI:1932614385
Name:MARTINEZ, RAQUEL (CEO)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 NW NORTH RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2240
Mailing Address - Country:US
Mailing Address - Phone:786-314-2979
Mailing Address - Fax:
Practice Address - Street 1:1911 NW NORTH RIVER DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2240
Practice Address - Country:US
Practice Address - Phone:786-314-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst