MEDICARE: MRS. MIRTHA ERIKA LOPEZ MARTINEZ RBT

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	106S00000X	Behavior Technician	RBT-24-334707	FL

General Provider Information

NPI Number	:	1861947319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRTHA ERIKA LOPEZ MARTINEZ RBT

Provider Business Mailing Address
First Line	:	15455 SW 119TH TER STE 201
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-6804
Country	:	US
Telephone Number	:	786-747-1039
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 CORAL WAY STE 2-19
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3438
Country	:	US
Telephone Number	:	305-508-5580
Fax Number	:

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

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	10/02/2025

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