Provider Demographics
NPI:1659081537
Name:MARTINEZ, CARMEN BEATRICE
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:BEATRICE
Last Name: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 1:3050 LA SPEZIA CIR APT 200
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-1166
Mailing Address - Country:US
Mailing Address - Phone:347-641-1400
Mailing Address - Fax:
Practice Address - Street 1:3050 LA SPEZIA CIR APT 200
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-1166
Practice Address - Country:US
Practice Address - Phone:347-641-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health