MEDICARE: GLENDA MARTINEZ, PH.D,, P.A.

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1790053155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDA MARTINEZ, PH.D,, P.A.

Provider Business Mailing Address
First Line	:	3408 W 84TH ST STE 310
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4944
Country	:	US
Telephone Number	:	305-826-6969
Fax Number	:

Provider Business Practice Location Address
First Line	:	3408 W 84TH ST STE 310
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4944
Country	:	US
Telephone Number	:	305-826-6969
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. GLENDA MARTINEZ
Credential	:	PH.D.
Telephone Number	:	305-826-6969

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	12/13/2011

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