Healthcare Provider Details

I. General information

NPI: 1134198112
Provider Name (Legal Business Name): CARMEN M DE LEON-MARTINEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARMEN DE LEON MD

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/26/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18610 NW 87TH AVE STE 101
HIALEAH FL
33015-3519
US

IV. Provider business mailing address

5010 HOLLYWOOD BLVD 100B
HOLLYWOOD FL
33021-6557
US

V. Phone/Fax

Practice location:
  • Phone: 305-829-5000
  • Fax:
Mailing address:
  • Phone: 954-967-0028
  • Fax: 954-967-8141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13338
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: