Provider Demographics
NPI:1821572421
Name:MARTINEZ, BRENDA (MS)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 SW 153RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4712
Mailing Address - Country:US
Mailing Address - Phone:786-266-2028
Mailing Address - Fax:
Practice Address - Street 1:10200 NW 25TH ST # A-108
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5921
Practice Address - Country:US
Practice Address - Phone:786-717-5649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2022-08-10
Deactivation Date:2021-05-14
Deactivation Code:
Reactivation Date:2021-10-28
Provider Licenses
StateLicense IDTaxonomies
FLSZ10367235Z00000X
FLSA20658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist