MEDICARE: STEPHANIE MARTINEZ BCBA

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	12471036	FL

General Provider Information

NPI Number	:	1528822715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARTINEZ BCBA

Provider Business Mailing Address
First Line	:	18245 SW 228TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33170-5400
Country	:	US
Telephone Number	:	786-859-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	18245 SW 228TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33170-5400
Country	:	US
Telephone Number	:	786-859-5544
Fax Number	:

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

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	02/08/2024

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Directions to “ STEPHANIE MARTINEZ BCBA” Practice Location

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