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General NPI Number Information
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NPI Number | 1356864912
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Entity Type | Individual
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Provider Name | MIRVYS MARTINEZ RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 26790 SW 142ND AVE APT 207
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City | NARANJA
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State | FL
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Zip | 33032-5427
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Country | US
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Telephone | 786-612-1796
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Fax |
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Provider Business Mailing Address
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Address Line | 5599 NW 5TH ST APT C32
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City | MIAMI
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State | FL
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Zip | 33126-3245
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-80459
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License Number State | FL
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