MEDICARE: YESIEL ALVAREZ MARTINEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-22-199596	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-22-199596	OTHER	FL	BACB

General Provider Information

NPI Number	:	1407589948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESIEL ALVAREZ MARTINEZ

Provider Business Mailing Address
First Line	:	3644 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5247
Country	:	US
Telephone Number	:	786-804-1250
Fax Number	:

Provider Business Practice Location Address
First Line	:	3644 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5247
Country	:	US
Telephone Number	:	786-804-1250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	07/01/2022

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