Provider Demographics
NPI:1902260912
Name:DR. ANGELA M. MARTINEZ, P.A.
Entity Type:Organization
Organization Name:DR. ANGELA M. MARTINEZ, P.A.
Other - Org Name:DR. ANGELA M. RODRIGUEZ, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:305-951-9272
Mailing Address - Street 1:19430 SW 88TH CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8937
Mailing Address - Country:US
Mailing Address - Phone:305-951-9272
Mailing Address - Fax:305-378-6839
Practice Address - Street 1:19430 SW 88TH CT
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8937
Practice Address - Country:US
Practice Address - Phone:305-951-9272
Practice Address - Fax:305-378-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1190101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty