Provider Demographics
NPI:1811659246
Name:MARTINEZ, GILBERTO ANGEL III
Entity type:Individual
Prefix:MR
First Name:GILBERTO
Middle Name:ANGEL
Last Name:MARTINEZ
Suffix:III
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 1:9811 S I-35 FRONTAGE RD
Mailing Address - Street 2:UNIT 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744
Mailing Address - Country:US
Mailing Address - Phone:888-308-3728
Mailing Address - Fax:
Practice Address - Street 1:9811 S INTERSTATE 35 BLDG 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-7901
Practice Address - Country:US
Practice Address - Phone:888-308-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-186592106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-21-186592OtherBACB