Provider Demographics
NPI:1902482565
Name:MARTINEZ BOSCH, MAYTE
Entity Type:Individual
Prefix:
First Name:MAYTE
Middle Name:
Last Name:MARTINEZ BOSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SW 12TH AVE APT 704
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-2464
Mailing Address - Country:US
Mailing Address - Phone:305-989-9306
Mailing Address - Fax:
Practice Address - Street 1:420 SW 12TH AVE APT 704
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2464
Practice Address - Country:US
Practice Address - Phone:305-989-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician