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General NPI Number Information
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NPI Number | 1831756196
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Entity Type | Individual
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Provider Name | MARIELYS MARTINEZ IZQUIERDO BCABA
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Gender | Female
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 897 TOWNE CENTER DR STE 101
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City | KISSIMMEE
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State | FL
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Zip | 34759-3473
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Country | US
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Telephone | 786-616-3573
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Fax |
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Provider Business Mailing Address
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Address Line | 5647 SYCAMORE CANYON DR
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City | KISSIMMEE
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State | FL
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Zip | 34758-1727
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Country | US
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Telephone | 786-616-3573
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA23074
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-20-10845
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License Number State | FL
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