Healthcare Provider Details

I. General information

NPI: 1053099341
Provider Name (Legal Business Name): SARAH E FONSECA-MARTINEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 TOWER POINT CIR
LAKE WALES FL
33859-5465
US

IV. Provider business mailing address

427 TOWER POINT CIR
LAKE WALES FL
33859-5465
US

V. Phone/Fax

Practice location:
  • Phone: 407-233-8742
  • Fax:
Mailing address:
  • Phone: 407-233-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-282892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: