Provider Demographics
NPI:1851185193
Name:BOUZA MARTINEZ, JOSE R (RBT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:BOUZA MARTINEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 NW 187TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2741
Mailing Address - Country:US
Mailing Address - Phone:786-616-6739
Mailing Address - Fax:
Practice Address - Street 1:4030 NW 187TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2741
Practice Address - Country:US
Practice Address - Phone:786-616-6739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1033315106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician