Healthcare Provider Details

I. General information

NPI: 1780450312
Provider Name (Legal Business Name): SANDRA MARTINEZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 NW 142ND AVE
GAINESVILLE FL
32609-4384
US

IV. Provider business mailing address

2008 NW 142ND AVE
GAINESVILLE FL
32609-4384
US

V. Phone/Fax

Practice location:
  • Phone: 352-672-7624
  • Fax:
Mailing address:
  • Phone: 352-672-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY9673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: