Healthcare Provider Details

I. General information

NPI: 1386269777
Provider Name (Legal Business Name): AMY E MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 OAKS WAY
POMPANO BEACH FL
33069-5391
US

IV. Provider business mailing address

3520 OAKS WAY
POMPANO BEACH FL
33069-5391
US

V. Phone/Fax

Practice location:
  • Phone: 786-294-0537
  • Fax: 305-807-1909
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: