Healthcare Provider Details

I. General information

NPI: 1861820326
Provider Name (Legal Business Name): ANNETTE MARTINEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 NW 52ND TER
DORAL FL
33166-7811
US

IV. Provider business mailing address

8350 NW 52ND TER
DORAL FL
33166-7811
US

V. Phone/Fax

Practice location:
  • Phone: 305-463-6600
  • Fax: 305-463-6659
Mailing address:
  • Phone: 305-463-6600
  • Fax: 305-463-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN2508952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: