Provider Demographics
NPI:1013131986
Name:MARTINEZ, IVETTE (LMT)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 SW 18TH ST
Mailing Address - Street 2:APT 418
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1625
Mailing Address - Country:US
Mailing Address - Phone:786-286-6256
Mailing Address - Fax:
Practice Address - Street 1:7175 SW 8TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4676
Practice Address - Country:US
Practice Address - Phone:305-269-8427
Practice Address - Fax:305-269-8429
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39857225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist