Provider Demographics
NPI:1033412416
Name:MARTIN FERNANDEZ, REBECA
Entity Type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:
Last Name:MARTIN FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 SW 66TH ST APT C4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2285
Mailing Address - Country:US
Mailing Address - Phone:786-975-6294
Mailing Address - Fax:305-387-1621
Practice Address - Street 1:14105 SW 66TH ST APT C4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2285
Practice Address - Country:US
Practice Address - Phone:786-975-6294
Practice Address - Fax:305-387-1621
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL44690225700000X
FL13254224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist