Healthcare Provider Details

I. General information

NPI: 1124974951
Provider Name (Legal Business Name): YUSIMI MARTINEZ AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 NE 5TH AVE
CAPE CORAL FL
33909-6889
US

IV. Provider business mailing address

2905 NE 5TH AVE
CAPE CORAL FL
33909-6889
US

V. Phone/Fax

Practice location:
  • Phone: 239-471-8077
  • Fax:
Mailing address:
  • Phone: 239-471-8077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-103036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: