Healthcare Provider Details

I. General information

NPI: 1457176091
Provider Name (Legal Business Name): RANDY LEON MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7971 RIVIERA BLVD STE 203
MIRAMAR FL
33023-6446
US

IV. Provider business mailing address

3969 SW 142ND AVE
MIAMI FL
33175-6450
US

V. Phone/Fax

Practice location:
  • Phone: 786-508-3245
  • Fax: 561-634-2814
Mailing address:
  • Phone: 786-482-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-385191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: