Healthcare Provider Details

I. General information

NPI: 1932614005
Provider Name (Legal Business Name): YADIRA MARTINEZ REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15450 SW 46TH LN
MIAMI FL
33185-5223
US

IV. Provider business mailing address

15450 SW 46TH LN
MIAMI FL
33185-5223
US

V. Phone/Fax

Practice location:
  • Phone: 786-618-8087
  • Fax:
Mailing address:
  • Phone: 786-618-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberM236826596000
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberM236826596000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: