Provider Demographics
NPI:1588327217
Name:MARTINEZ SOTO, YANEISY
Entity type:Individual
Prefix:
First Name:YANEISY
Middle Name:
Last Name:MARTINEZ SOTO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 PALMETTO FRNTG RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1557
Mailing Address - Country:US
Mailing Address - Phone:954-281-5041
Mailing Address - Fax:
Practice Address - Street 1:14100 PALMETTO FRNTG RD STE 108
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1568
Practice Address - Country:US
Practice Address - Phone:954-281-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016110363LF0000X, 363LP0808X
TX1195790363LP0808X
AZTELE322154363LP0808X
WAAP61682263363LP0808X
NE115980363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily