Healthcare Provider Details

I. General information

NPI: 1255810651
Provider Name (Legal Business Name): KAILUMA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

1515 NW 182ND AVE
PEMBROKE PINES FL
33029-3042
US

V. Phone/Fax

Practice location:
  • Phone: 954-459-2094
  • Fax:
Mailing address:
  • Phone: 305-450-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS15724
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberUO4875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: