MEDICARE: IDIANET MARTINEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-1864787	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235613134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDIANET MARTINEZ

Provider Business Mailing Address
First Line	:	1133 NW JUANITA PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-1112
Country	:	US
Telephone Number	:	305-772-1339
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 NW JUANITA PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-1112
Country	:	US
Telephone Number	:	305-772-1339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	03/09/2026

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Directions to “ IDIANET MARTINEZ ” Practice Location

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