Provider Demographics
NPI:1336851203
Name:MARTINEZ, CHARLOTTE ISABELA
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ISABELA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 E IRLO BRONSON MEMORIAL HWY STE D
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5600
Mailing Address - Country:US
Mailing Address - Phone:407-483-4750
Mailing Address - Fax:407-201-6260
Practice Address - Street 1:1900 SAN MARTINO LN APT 413
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-1185
Practice Address - Country:US
Practice Address - Phone:347-641-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health