Healthcare Provider Details

I. General information

NPI: 1851917983
Provider Name (Legal Business Name): MADELIN GARCIA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 SW 253RD ST
HOMESTEAD FL
33032-6037
US

IV. Provider business mailing address

11511 SW 253RD ST
HOMESTEAD FL
33032-6037
US

V. Phone/Fax

Practice location:
  • Phone: 786-317-3124
  • Fax:
Mailing address:
  • Phone: 786-317-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-122828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: