MEDICARE: ELIZABETH MARTINEZ CABALLERO

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	20-143460	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	:	1255926119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARTINEZ CABALLERO

Provider Business Mailing Address
First Line	:	3112 EGREMONT DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5027
Country	:	US
Telephone Number	:	561-225-8582
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 EGREMONT DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5027
Country	:	US
Telephone Number	:	561-225-8582
Fax Number	:

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

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	03/03/2021

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