Provider Demographics
NPI:1366269391
Name:MARTINEZ-BAHAMONDE, ELVIRA ISABELLE
Entity type:Individual
Prefix:
First Name:ELVIRA
Middle Name:ISABELLE
Last Name:MARTINEZ-BAHAMONDE
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 1:4732 GRAPEVINE WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3355
Mailing Address - Country:US
Mailing Address - Phone:954-937-2129
Mailing Address - Fax:954-333-2220
Practice Address - Street 1:4732 GRAPEVINE WAY
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-3355
Practice Address - Country:US
Practice Address - Phone:954-937-2129
Practice Address - Fax:954-333-2220
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician