Healthcare Provider Details

I. General information

NPI: 1548941719
Provider Name (Legal Business Name): RICEL MARTINEZ I BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8526 SW 207TH TER
CUTLER BAY FL
33189-3300
US

IV. Provider business mailing address

8526 SW 207TH TER
CUTLER BAY FL
33189-3300
US

V. Phone/Fax

Practice location:
  • Phone: 786-604-7049
  • Fax:
Mailing address:
  • Phone: 786-604-7049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2832235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: