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General NPI Number Information
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NPI Number | 1811659246
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Entity Type | Individual
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Provider Name | MR. GILBERTO ANGEL MARTINEZ III
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Gender | Male
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 9811 S INTERSTATE 35 BLDG 1
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City | AUSTIN
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State | TX
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Zip | 78744-7901
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Country | US
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Telephone | 888-308-3728
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Fax |
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Provider Business Mailing Address
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Address Line | 9811 S I-35 FRONTAGE RD UNIT 100
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City | AUSTIN
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State | TX
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Zip | 78744
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Country | US
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Telephone | 888-308-3728
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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-21-186592
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License Number State | TX
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