Provider Demographics
NPI:1942986062
Name:MARTINEZ, JUAN CARLOS (CBHCM)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8822 W FLAGLER ST APT 9
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2363
Mailing Address - Country:US
Mailing Address - Phone:786-856-5776
Mailing Address - Fax:
Practice Address - Street 1:900 E 9TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4650
Practice Address - Country:US
Practice Address - Phone:305-381-5294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0105008171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator