Provider Demographics
NPI:1023074531
Name:MARTINEZ, IVETTE M (LMT)
Entity type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:M
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 1:13048 WATERFORD WOOD CIR
Mailing Address - Street 2:APT 201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6054
Mailing Address - Country:US
Mailing Address - Phone:407-508-5768
Mailing Address - Fax:407-313-9796
Practice Address - Street 1:13048 WATERFORD WOOD CIR
Practice Address - Street 2:APT 201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6054
Practice Address - Country:US
Practice Address - Phone:407-508-5768
Practice Address - Fax:407-313-9796
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist