Provider Demographics
NPI:1750069050
Name:ALONSO MARTINEZ, AVELINO
Entity type:Individual
Prefix:
First Name:AVELINO
Middle Name:
Last Name:ALONSO MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 NW 102ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-1530
Mailing Address - Country:US
Mailing Address - Phone:786-689-8495
Mailing Address - Fax:
Practice Address - Street 1:12955 SW 132ND ST STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6224
Practice Address - Country:US
Practice Address - Phone:305-220-3382
Practice Address - Fax:305-220-3383
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-281757106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician