Healthcare Provider Details

I. General information

NPI: 1306131040
Provider Name (Legal Business Name): ISIDRO R. MARTINEZ MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7153 VIA FIRENZE
BOCA RATON FL
33433-1044
US

IV. Provider business mailing address

7153 VIA FIRENZE
BOCA RATON FL
33433-1044
US

V. Phone/Fax

Practice location:
  • Phone: 561-866-8448
  • Fax: 561-392-3402
Mailing address:
  • Phone: 561-866-8448
  • Fax: 561-392-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberME94896
License Number StateFL

VIII. Authorized Official

Name: DR. ISIDRO RICARDO MARTINEZ
Title or Position: OWNER/MANAGER
Credential: MD
Phone: 561-866-8448