Provider Demographics
NPI:1396508172
Name:MARTINEZ PEREZ, ISEL MARILUZ
Entity type:Individual
Prefix:
First Name:ISEL
Middle Name:MARILUZ
Last Name:MARTINEZ PEREZ
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 1:7420 W 20TH AVE APT 255
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5545
Mailing Address - Country:US
Mailing Address - Phone:786-478-5470
Mailing Address - Fax:
Practice Address - Street 1:7420 W 20TH AVE APT 255
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5545
Practice Address - Country:US
Practice Address - Phone:786-478-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-323245106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician