MEDICARE: CLARA MARTINEZ I

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		FL

General Provider Information

NPI Number	:	1467803809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA MARTINEZ I

Provider Business Mailing Address
First Line	:	14030 BISCAYNE BLVD APT 701
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33181-1549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7601 E TREASURE DR # CU1
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4391
Country	:	US
Telephone Number	:	305-302-8022
Fax Number	:

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

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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