Healthcare Provider Details

I. General information

NPI: 1437836731
Provider Name (Legal Business Name): GERENNY BOTANA MARTELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 NW 151ST ST STE 127
MIAMI LAKES FL
33014-2442
US

IV. Provider business mailing address

12410 SW 25TH ST
MIAMI FL
33175-1905
US

V. Phone/Fax

Practice location:
  • Phone: 786-905-2262
  • Fax:
Mailing address:
  • Phone: 305-772-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-281175
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA1-25-86869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: