Healthcare Provider Details

I. General information

NPI: 1922914639
Provider Name (Legal Business Name): VIVIAN MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 NW 53RD TER STE 512D
DORAL FL
33166-4851
US

IV. Provider business mailing address

5531 NW 112TH AVE APT 104
DORAL FL
33178-4123
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-1517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPSI24934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: