Healthcare Provider Details

I. General information

NPI: 1669049516
Provider Name (Legal Business Name): SUSANA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 17TH AVE SW
NAPLES FL
34117-6121
US

IV. Provider business mailing address

1921 N 62ND AVE
HOLLYWOOD FL
33024-4242
US

V. Phone/Fax

Practice location:
  • Phone: 954-709-7963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-111874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: