Provider Demographics
NPI:1497407845
Name:ROQUE MARTINEZ, CHAVELY
Entity Type:Individual
Prefix:
First Name:CHAVELY
Middle Name:
Last Name:ROQUE 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 1:2311 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3223
Mailing Address - Country:US
Mailing Address - Phone:786-706-2246
Mailing Address - Fax:786-709-9388
Practice Address - Street 1:2311 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3223
Practice Address - Country:US
Practice Address - Phone:786-706-2246
Practice Address - Fax:786-709-9388
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty