Healthcare Provider Details

I. General information

NPI: 1619697455
Provider Name (Legal Business Name): AMAYA MARTINEZ DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 01/03/2023
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 N STATE ROAD 7 STE 300
LAUDERDALE LAKES FL
33319-5867
US

IV. Provider business mailing address

7793 NW 201ST TER
HIALEAH FL
33015-5988
US

V. Phone/Fax

Practice location:
  • Phone: 561-323-6582
  • Fax:
Mailing address:
  • Phone: 786-619-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: