Healthcare Provider Details

I. General information

NPI: 1194848234
Provider Name (Legal Business Name): KIANFA MARTINEZ-LU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE 412
HIALEAH FL
33016-1811
US

IV. Provider business mailing address

13003 SW 42ND TER
MIAMI FL
33175-4005
US

V. Phone/Fax

Practice location:
  • Phone: 954-322-1110
  • Fax: 954-322-1099
Mailing address:
  • Phone: 786-897-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME103812
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number062556
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME103812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: