Healthcare Provider Details

I. General information

NPI: 1104668094
Provider Name (Legal Business Name): ELIZABETH BARRERAS MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 W 24TH AVE APT 2287
HIALEAH FL
33016-6532
US

IV. Provider business mailing address

5619 NW 190TH LN
MIAMI GARDENS FL
33055-2354
US

V. Phone/Fax

Practice location:
  • Phone: 786-543-5390
  • Fax:
Mailing address:
  • Phone: 786-543-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-352225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: