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General NPI Number Information
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NPI Number | 1518319730
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Entity Type | Organization
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Legal Business Name | SAVANNAH MARTINEZ
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 2977 FIREWHEEL DR
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City | ROCKWALL
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State | TX
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Zip | 75032-7321
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Country | US
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Telephone | 210-763-6259
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Fax |
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Provider Business Mailing Address
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Address Line | 2977 FIREWHEEL DR
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City | ROCKWALL
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State | TX
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Zip | 75032-7321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ABA THERAPIST
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Name | MRS. SAVANNAH MARTINEZ
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Credential | RBT
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Telephone | 210-763-6259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | RBT-14-00326
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License Number State | TX
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