Provider Demographics
NPI:1619734944
Name:MARTINEZ FUENTES, GRETHELL
Entity Type:Individual
Prefix:
First Name:GRETHELL
Middle Name:
Last Name:MARTINEZ FUENTES
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 1:2917 NE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-6889
Mailing Address - Country:US
Mailing Address - Phone:239-810-3182
Mailing Address - Fax:
Practice Address - Street 1:2917 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-6889
Practice Address - Country:US
Practice Address - Phone:239-810-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-318376106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician