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General NPI Number Information
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NPI Number | 1659233179
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Entity Type | Individual
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Provider Name | SANTRELL MARTINEZ
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Gender | Male
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 111 W NEW HAVEN AVE
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City | MELBOURNE
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State | FL
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Zip | 32901-4302
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Country | US
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Telephone | 772-584-0815
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Fax |
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Provider Business Mailing Address
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Address Line | 3611 5TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33713-7503
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Country | US
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Telephone | 727-327-3332
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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 | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | POR389
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | POR389
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License Number State | FL
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