Provider Demographics
NPI:1003705732
Name:MARTINEZ, ANDREA GABRIELLA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:GABRIELLA
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 1:3898 KNOTTY PINE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-6307
Mailing Address - Country:US
Mailing Address - Phone:813-808-1670
Mailing Address - Fax:
Practice Address - Street 1:150 3RD ST SW STE 109
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2980
Practice Address - Country:US
Practice Address - Phone:863-271-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician