Provider Demographics
NPI:1376810259
Name:MARTINEZ, LORENA (MASTERS)
Entity Type:Individual
Prefix:MS
First Name:LORENA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 POPPY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-8813
Mailing Address - Country:US
Mailing Address - Phone:917-753-2967
Mailing Address - Fax:718-281-8523
Practice Address - Street 1:17615 FRANJO RD
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5636
Practice Address - Country:US
Practice Address - Phone:786-268-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X, 222Q00000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
No174400000XOther Service ProvidersSpecialist