Provider Demographics
NPI:1700373073
Name:FALCON AVALOS, MARTHA IRENE
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:IRENE
Last Name:FALCON AVALOS
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 1:1970 RIVER REACH DR APT 179
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-5240
Mailing Address - Country:US
Mailing Address - Phone:305-790-5273
Mailing Address - Fax:
Practice Address - Street 1:1970 RIVER REACH DR APT 179
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-5240
Practice Address - Country:US
Practice Address - Phone:305-790-5273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-22
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022715900Medicaid