Individual
MAURICIO MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20342 SW 129TH PL, MIAMI, FL 33177-5506
(786) 457-0743
Mailing address
20342 SW 129TH PL, MIAMI, FL 33177-5506
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
11-1158-GH
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016584900
—
FL
Enumeration date
09/14/2016
Last updated
09/14/2016
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