Provider Demographics
NPI:1083403232
Name:MARTINEZ CAPOTE, JIANISER
Entity type:Individual
Prefix:
First Name:JIANISER
Middle Name:
Last Name:MARTINEZ CAPOTE
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 1:3823 BAY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2679
Mailing Address - Country:US
Mailing Address - Phone:407-750-0337
Mailing Address - Fax:
Practice Address - Street 1:3823 BAY CLUB CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2679
Practice Address - Country:US
Practice Address - Phone:407-750-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-25-431851106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician