Individual
AMANDA MEDINA MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2231 SW 43RD TER, FORT LAUDERDALE, FL 33317-6633
(954) 270-4077
Mailing address
2231 SW 43RD TER, FORT LAUDERDALE, FL 33317-6633
(954) 270-4077
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-31-8989
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121509400
—
FL
Enumeration date
02/02/2024
Last updated
12/27/2024
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