Healthcare Provider Details

I. General information

NPI: 1831756196
Provider Name (Legal Business Name): MARIELYS MARTINEZ IZQUIERDO BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 TOWNE CENTER DR STE 101
KISSIMMEE FL
34759-3473
US

IV. Provider business mailing address

5647 SYCAMORE CANYON DR
KISSIMMEE FL
34758-1727
US

V. Phone/Fax

Practice location:
  • Phone: 786-616-3573
  • Fax:
Mailing address:
  • Phone: 786-616-3573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA23074
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-20-10845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: