Provider Demographics
NPI:1528942554
Name:SAN MARTIN, JIMMY ARMANDO
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:ARMANDO
Last Name:SAN MARTIN
Suffix:
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 1:1453 NW 153RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2451
Mailing Address - Country:US
Mailing Address - Phone:786-317-6692
Mailing Address - Fax:
Practice Address - Street 1:1453 NW 153RD AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2451
Practice Address - Country:US
Practice Address - Phone:786-317-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4621101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor