Healthcare Provider Details

I. General information

NPI: 1114764990
Provider Name (Legal Business Name): GLORIA BRIGUITE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 S 27TH ST
MILWAUKEE WI
53221-2145
US

IV. Provider business mailing address

1032 S CESAR E CHAVEZ DR
MILWAUKEE WI
53204-2203
US

V. Phone/Fax

Practice location:
  • Phone: 414-290-4105
  • Fax: 414-290-4574
Mailing address:
  • Phone: 414-672-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: