Healthcare Provider Details

I. General information

NPI: 1750069050
Provider Name (Legal Business Name): AVELINO ALONSO MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 NW 17TH ST
CAPE CORAL FL
33993-4907
US

IV. Provider business mailing address

1714 NW 17TH ST
CAPE CORAL FL
33993-4907
US

V. Phone/Fax

Practice location:
  • Phone: 786-689-8495
  • Fax:
Mailing address:
  • Phone: 786-689-8495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86825
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: