Provider Demographics
NPI:1194407106
Name:MARTINEZ OBREGON, ISABEL
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:MARTINEZ OBREGON
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 1:8507 CEDAR GARDEN DR # 202D
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2174
Mailing Address - Country:US
Mailing Address - Phone:561-985-8968
Mailing Address - Fax:
Practice Address - Street 1:8507 CEDAR GARDEN DR # 202D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2174
Practice Address - Country:US
Practice Address - Phone:561-985-8968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-288245106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician