MEDICARE: MR. ALBERTO MARTIR

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	175T00000X	Peer Specialist		OH

General Provider Information

NPI Number	:	1598377277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERTO MARTIR

Provider Business Mailing Address
First Line	:	1379 LANDER RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-1653
Country	:	US
Telephone Number	:	440-773-4572
Fax Number	:

Provider Business Practice Location Address
First Line	:	1379 LANDER RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-1653
Country	:	US
Telephone Number	:	440-773-4572
Fax Number	:

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

Provider Enumeration Date	:	08/23/2020
Last Update Date	:	08/23/2020

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Directions to “ MR. ALBERTO MARTIR ” Practice Location

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