Healthcare Provider Details

I. General information

NPI: 1306121041
Provider Name (Legal Business Name): PAULETTE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6290 SW 47TH CT
DAVIE FL
33314-4456
US

IV. Provider business mailing address

6290 SW 47TH CT
DAVIE FL
33314-4456
US

V. Phone/Fax

Practice location:
  • Phone: 305-878-0071
  • Fax:
Mailing address:
  • Phone: 305-878-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: