Provider Demographics
NPI:1023440039
Name:MARTINEZ, JOSE RAFAEL
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAFAEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SW 16TH ST APT 12
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1437
Mailing Address - Country:US
Mailing Address - Phone:305-989-3628
Mailing Address - Fax:
Practice Address - Street 1:945 CENTER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-2026
Practice Address - Country:US
Practice Address - Phone:352-273-2184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1306192778OtherBEHAVIOR ANALYSIS RESEARCH CLINIC