Provider Demographics
NPI:1275416026
Name:MARTINEZ, LETICIA JOSEFINA
Entity type:Individual
Prefix:MISS
First Name:LETICIA
Middle Name:JOSEFINA
Last Name: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 1:190 INDEPENDENCE LANE
Mailing Address - Street 2:APT 418
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-274-1028
Mailing Address - Fax:
Practice Address - Street 1:190 INDEPENDENCE LN UNIT 418
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5671
Practice Address - Country:US
Practice Address - Phone:407-274-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT25444259106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician