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General NPI Number Information
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NPI Number | 1538855846
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Entity Type | Individual
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Provider Name | GRETTELL BARRETO MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 6702 N GUNLOCK AVE
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City | TAMPA
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State | FL
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Zip | 33614-4508
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Country | US
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Telephone | 813-418-9038
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Fax |
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Provider Business Mailing Address
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Address Line | 3853 NORTHDALE BLVD STE 155
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City | TAMPA
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State | FL
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Zip | 33624-1861
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-231135
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License Number State | FL
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