Provider Demographics
NPI:1023793189
Name:CANEJA, MARTHA ELENA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELENA
Last Name:CANEJA
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 1:2420 SW 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5758
Mailing Address - Country:US
Mailing Address - Phone:305-205-9145
Mailing Address - Fax:
Practice Address - Street 1:2420 SW 86TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5758
Practice Address - Country:US
Practice Address - Phone:305-205-9145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2025-01-14
Deactivation Date:2025-01-02
Deactivation Code:
Reactivation Date:2025-01-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst