MEDICARE: VIRGINIA MARTIN

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		FL

General Provider Information

NPI Number	:	1275311342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA MARTIN

Provider Business Mailing Address
First Line	:	3205 W 16TH AVE LOT D72
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4632
Country	:	US
Telephone Number	:	786-319-6547
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 W 16TH AVE LOT D72
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4632
Country	:	US
Telephone Number	:	786-319-6547
Fax Number	:

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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Directions to “ VIRGINIA MARTIN ” Practice Location

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