MEDICARE: JUAN CARLOS MARTINEZ CBHCM

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	171M00000X	Case Manager/Care Coordinator	CBHCM.0105008	FL

General Provider Information

NPI Number	:	1942986062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN CARLOS MARTINEZ CBHCM

Provider Business Mailing Address
First Line	:	8822 W FLAGLER ST APT 9
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-2363
Country	:	US
Telephone Number	:	786-856-5776
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 E 9TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4650
Country	:	US
Telephone Number	:	305-381-5294
Fax Number	:

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

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	06/23/2023

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