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General NPI Number Information
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NPI Number | 1356018311
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Entity Type | Organization
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Legal Business Name | MART MEDICAL GROUP INC
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 8140 OKEECHOBEE BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-2003
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Country | US
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Telephone | 561-437-8241
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Fax |
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Provider Business Mailing Address
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Address Line | 8140 OKEECHOBEE BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-2003
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Country | US
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Telephone | 561-437-8241
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERTO MARTINEZ TORRES
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Credential |
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Telephone | 305-342-4737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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