Provider Demographics
NPI:1144948654
Name:MARTINEZ VALERON, LILIAN
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:MARTINEZ VALERON
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 1:110 CAPCOM AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6531
Mailing Address - Country:US
Mailing Address - Phone:919-594-1879
Mailing Address - Fax:
Practice Address - Street 1:6752 OLDE PROVINCE CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5378
Practice Address - Country:US
Practice Address - Phone:786-620-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-174773106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician