Healthcare Provider Details

I. General information

NPI: 1922877919
Provider Name (Legal Business Name): REBECCA ISABEL MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 S DIXIE HWY
PINECREST FL
33156-6529
US

IV. Provider business mailing address

4721 SW 162ND PL
MIAMI FL
33185-5154
US

V. Phone/Fax

Practice location:
  • Phone: 786-467-5765
  • Fax:
Mailing address:
  • Phone: 305-401-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL5263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: