Provider Demographics
NPI:1760030035
Name:MARTINEZ RUIZ, KAREN M
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:MARTINEZ RUIZ
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 1:15300 SW 284TH ST APT 18
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1379
Mailing Address - Country:US
Mailing Address - Phone:407-624-2905
Mailing Address - Fax:
Practice Address - Street 1:15300 SW 284TH ST APT 18
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1379
Practice Address - Country:US
Practice Address - Phone:407-624-2905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-81234106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician