Individual
MAIRA MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RLT
Contact information
Practice address
7330 FERN AVE STE 1001, SHREVEPORT, LA 71105-4988
(318) 641-0444
(318) 641-6115
Mailing address
7330 FERN AVE STE 1001, SHREVEPORT, LA 71105-4988
(318) 641-0444
(318) 641-6115
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
R11688
LA
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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