MEDICARE: MARISSA ANN MARTINEZ

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		TX

General Provider Information

NPI Number	:	1558292862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA ANN MARTINEZ

Provider Business Mailing Address
First Line	:	9701 TERRA LAGO CT
Second Line	:	APT A116
City	:	ROWLETT
State	:	TX
Zip	:	75089
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 ABRAMS RD # 112
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2000
Country	:	US
Telephone Number	:	469-906-6372
Fax Number	:

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

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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Directions to “ MARISSA ANN MARTINEZ ” Practice Location

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