Provider Demographics
NPI:1316460280
Name:CAMACHO MARTINEZ, ARIELVIS
Entity type:Individual
Prefix:
First Name:ARIELVIS
Middle Name:
Last Name:CAMACHO 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 1:6935 W 2ND LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5311
Mailing Address - Country:US
Mailing Address - Phone:786-440-9416
Mailing Address - Fax:
Practice Address - Street 1:6935 W 2ND LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5311
Practice Address - Country:US
Practice Address - Phone:786-440-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-18-67343106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician