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General NPI Number Information
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NPI Number | 1629591912
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Entity Type | Individual
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Provider Name | GISSELLE MARIA MARTINEZ PEDRERA
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Gender | Female
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9031 SW 122ND AVE APT 112
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City | MIAMI
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State | FL
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Zip | 33186-2015
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Country | US
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Telephone | 786-592-2263
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Fax |
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Provider Business Mailing Address
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Address Line | 10260 SW 4TH ST
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City | MIAMI
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State | FL
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Zip | 33174-1711
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Country | US
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Telephone | 786-592-2263
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-42781
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License Number State | FL
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