MEDICARE: VIVIANA MARTINEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083172639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIANA MARTINEZ

Provider Business Mailing Address
First Line	:	4000 PINELLA CIR APT 499
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6725
Country	:	US
Telephone Number	:	321-917-8770
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 PINELLA CIR APT 499
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6725
Country	:	US
Telephone Number	:	321-917-8770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2019
Last Update Date	:	03/03/2019

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Directions to “ VIVIANA MARTINEZ ” Practice Location

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