MEDICARE: MRS. JUDITH MARTINEZ MA 42435

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0005X	Ambulatory Family Planning Facility	MA 42435	FL

General Provider Information

NPI Number	:	1760571715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH MARTINEZ MA 42435

Provider Business Mailing Address
First Line	:	4275 NW SOUTH TAMIAMI CANAL DR # DR.305
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-1483
Country	:	US
Telephone Number	:	305-244-8365
Fax Number	:	305-444-6969

Provider Business Practice Location Address
First Line	:	4275 NW SOUTH TAMIAMI CANAL DR # 305
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-1483
Country	:	US
Telephone Number	:	305-244-8365
Fax Number	:	305-444-6969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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