Healthcare Provider Details

I. General information

NPI: 1518834670
Provider Name (Legal Business Name): BRIZA Y SEVILLA MARTINEZ CBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 NE 13TH AVE
VANCOUVER WA
98665-9604
US

IV. Provider business mailing address

6610 NW WHITNEY RD UNIT 5
VANCOUVER WA
98665-7022
US

V. Phone/Fax

Practice location:
  • Phone: 360-984-3131
  • Fax: 360-718-8542
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB70062721
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: