MEDICARE: KATIA VAZQUEZ MARTINEZ B.A. CBHCMS

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	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386023521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIA VAZQUEZ MARTINEZ B.A. CBHCMS

Provider Business Mailing Address
First Line	:	1325 SE 47TH ST STE I-2
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9692
Country	:	US
Telephone Number	:	407-591-1460
Fax Number	:	239-319-4747

Provider Business Practice Location Address
First Line	:	1325 SE 47TH ST STE I-2
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9692
Country	:	US
Telephone Number	:	407-591-1460
Fax Number	:	239-319-4747

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

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	03/05/2026

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