Healthcare Provider Details

I. General information

NPI: 1114712643
Provider Name (Legal Business Name): YISEL MARTINEZ VALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17059 NW 60TH CT
HIALEAH FL
33015-4645
US

IV. Provider business mailing address

777 NW 72ND AVE STE 1083
MIAMI FL
33126-3176
US

V. Phone/Fax

Practice location:
  • Phone: 786-583-9992
  • Fax:
Mailing address:
  • Phone: 786-490-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-418258
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: