Provider Demographics
NPI:1245109438
Name:MARTINEZ VALLE, PEDRO PABLO
Entity type:Individual
Prefix:
First Name:PEDRO PABLO
Middle Name:
Last Name:MARTINEZ VALLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 S LIBERTY AVE APT B
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-2661
Mailing Address - Country:US
Mailing Address - Phone:786-914-8244
Mailing Address - Fax:
Practice Address - Street 1:1453 S LIBERTY AVE APT B
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-2661
Practice Address - Country:US
Practice Address - Phone:786-914-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-485481106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician