Healthcare Provider Details

I. General information

NPI: 1861006116
Provider Name (Legal Business Name): KERTIN MARTINEZ RODRIGUEZ CBHCMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SUNNILAND BLVD
LEHIGH ACRES FL
33971-5208
US

IV. Provider business mailing address

920 SUNNILAND BLVD
LEHIGH ACRES FL
33971-5208
US

V. Phone/Fax

Practice location:
  • Phone: 786-312-5828
  • Fax:
Mailing address:
  • Phone: 786-312-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: