Provider Demographics
NPI:1861914327
Name:ORTIZ MARTINEZ, MAYELIN I (BCABA)
Entity type:Individual
Prefix:MISS
First Name:MAYELIN
Middle Name:
Last Name:ORTIZ MARTINEZ
Suffix:I
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15969 NW 64TH AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5574
Mailing Address - Country:US
Mailing Address - Phone:786-389-6475
Mailing Address - Fax:
Practice Address - Street 1:15969 NW 64TH AVE APT 104
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-5574
Practice Address - Country:US
Practice Address - Phone:786-389-6475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL0-20-10780106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician