Provider Demographics
NPI:1689472276
Name:SOSA MARTINEZ, MAILEIDIS B
Entity type:Individual
Prefix:
First Name:MAILEIDIS
Middle Name:B
Last Name:SOSA MARTINEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 SW 153RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4723
Mailing Address - Country:US
Mailing Address - Phone:786-960-0618
Mailing Address - Fax:
Practice Address - Street 1:3530 SW 153RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4723
Practice Address - Country:US
Practice Address - Phone:786-960-0618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-413696106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty