Healthcare Provider Details

I. General information

NPI: 1699297945
Provider Name (Legal Business Name): IRANIA MARTINEZ RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3271 NW 7TH ST STE 203
MIAMI FL
33125-4141
US

IV. Provider business mailing address

9473 NW 49TH DORAL LN
DORAL FL
33178-2051
US

V. Phone/Fax

Practice location:
  • Phone: 786-220-6902
  • Fax:
Mailing address:
  • Phone: 786-234-8296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: