Provider Demographics
NPI:1326729005
Name:SHORT MARTINEZ, KARLA R
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:R
Last Name:SHORT MARTINEZ
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 1:230 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-2164
Mailing Address - Country:US
Mailing Address - Phone:402-708-9918
Mailing Address - Fax:
Practice Address - Street 1:897 TOWNE CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-3473
Practice Address - Country:US
Practice Address - Phone:407-201-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician