Healthcare Provider Details

I. General information

NPI: 1508264078
Provider Name (Legal Business Name): AIDA ROSA MARTINEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18710 SW 107TH AVE UNIT 17
CUTLER BAY FL
33157-6774
US

IV. Provider business mailing address

18710 SW 107TH AVE UNIT 17
CUTLER BAY FL
33157-6774
US

V. Phone/Fax

Practice location:
  • Phone: 786-772-1231
  • Fax: 833-468-5448
Mailing address:
  • Phone: 786-772-1231
  • Fax: 833-468-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9108198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: