Provider Demographics
NPI:1871187229
Name:MARTINEZ, GABRIEL A (IMH6190)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:IMH6190
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 SAN VITTORINO CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-1541
Mailing Address - Country:US
Mailing Address - Phone:407-446-2422
Mailing Address - Fax:
Practice Address - Street 1:11138 SWEETGUM WOODS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7924
Practice Address - Country:US
Practice Address - Phone:407-446-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH6190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health