Provider Demographics
NPI:1700620556
Name:RAMIREZ DIAZ, MARTHA CRISTINA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:CRISTINA
Last Name:RAMIREZ DIAZ
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 1:13165 SW 64TH TER STE 1007
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5637
Mailing Address - Country:US
Mailing Address - Phone:786-767-9003
Mailing Address - Fax:
Practice Address - Street 1:13165 SW 64TH TER STE 1007
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5637
Practice Address - Country:US
Practice Address - Phone:786-767-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-352831106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician