Healthcare Provider Details

I. General information

NPI: 1134809247
Provider Name (Legal Business Name): MAYELIN MARTINEZ TORREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
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

3248 NW 102ND ST
MIAMI FL
33147-1530
US

V. Phone/Fax

Practice location:
  • Phone: 754-261-5062
  • Fax:
Mailing address:
  • Phone: 754-261-5062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-286257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: