MEDICARE: MART MEDICAL GROUP INC

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	103K00000X	Behavior Analyst
2	251S00000X	Community/Behavioral Health Agency

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	:	1356018311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MART MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	8140 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2003
Country	:	US
Telephone Number	:	561-437-8241
Fax Number	:

Provider Business Practice Location Address
First Line	:	8140 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2003
Country	:	US
Telephone Number	:	561-437-8241
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERTO MARTINEZ TORRES
Credential	:
Telephone Number	:	305-342-4737

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	11/01/2022

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