Healthcare Provider Details

I. General information

NPI: 1235055211
Provider Name (Legal Business Name): JOHANNA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E NEWTON ST
BOSTON MA
02118-3553
US

IV. Provider business mailing address

4 CIRCUIT SQ APT 1
ROXBURY MA
02119-3595
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-8336
  • Fax:
Mailing address:
  • Phone: 617-224-2690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: