Healthcare Provider Details

I. General information

NPI: 1316192495
Provider Name (Legal Business Name): MARIO A MARTINEZ PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 SW 12TH ST
BOCA RATON FL
33486-6410
US

IV. Provider business mailing address

1741 SW 12TH ST
BOCA RATON FL
33486-6410
US

V. Phone/Fax

Practice location:
  • Phone: 561-756-4092
  • Fax:
Mailing address:
  • Phone: 561-756-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS36803
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPU5712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: