Provider Demographics
NPI:1265113096
Name:MARTINEZ MARTINEZ, PEDRO EMILIO I
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:EMILIO
Last Name:MARTINEZ MARTINEZ
Suffix:I
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 1:557 MERRIMAC TER APT B
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-3794
Mailing Address - Country:US
Mailing Address - Phone:786-878-3991
Mailing Address - Fax:
Practice Address - Street 1:4793 N CONGRESS AVE STE 204
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7937
Practice Address - Country:US
Practice Address - Phone:561-722-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician