Healthcare Provider Details

I. General information

NPI: 1194650192
Provider Name (Legal Business Name): ROBERTO DANIEL TERRERO MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7940 EMBASSY BLVD
MIRAMAR FL
33023-6412
US

IV. Provider business mailing address

7940 EMBASSY BLVD
MIRAMAR FL
33023-6412
US

V. Phone/Fax

Practice location:
  • Phone: 754-284-1156
  • Fax:
Mailing address:
  • Phone: 754-284-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberT633406793000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: