Healthcare Provider Details

I. General information

NPI: 1043477151
Provider Name (Legal Business Name): GEORGINA L. MARTIN BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17421 SW 144TH CT
MIAMI FL
33177
US

IV. Provider business mailing address

17421 SW 144TH CT
MIAMI FL
33177-6645
US

V. Phone/Fax

Practice location:
  • Phone: 786-556-8983
  • Fax:
Mailing address:
  • Phone: 786-556-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: