Provider Demographics
NPI:1548984594
Name:RODRIGUEZ MARTINEZ, YAIMA
Entity type:Individual
Prefix:
First Name:YAIMA
Middle Name:
Last Name:RODRIGUEZ MARTINEZ
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 1:5890 NW 186TH ST APT 305
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-8027
Mailing Address - Country:US
Mailing Address - Phone:786-201-4593
Mailing Address - Fax:
Practice Address - Street 1:5890 NW 186TH ST APT 305
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-8027
Practice Address - Country:US
Practice Address - Phone:786-201-4593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20140479106S00000X
FL115187300106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician