Healthcare Provider Details

I. General information

NPI: 1265113096
Provider Name (Legal Business Name): PEDRO EMILIO MARTINEZ MARTINEZ I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4793 N CONGRESS AVE STE 204
BOYNTON BEACH FL
33426-7937
US

IV. Provider business mailing address

557 MERRIMAC TER APT B
WEST PALM BEACH FL
33415-3794
US

V. Phone/Fax

Practice location:
  • Phone: 561-722-9107
  • Fax:
Mailing address:
  • Phone: 786-878-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: