Healthcare Provider Details

I. General information

NPI: 1457297749
Provider Name (Legal Business Name): STEFANY MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7275 N AUGUSTA DR
HIALEAH FL
33015-2076
US

IV. Provider business mailing address

12905 SW 132ND ST STE 1
MIAMI FL
33186-6293
US

V. Phone/Fax

Practice location:
  • Phone: 786-606-7601
  • Fax:
Mailing address:
  • Phone: 305-342-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-527367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: