Healthcare Provider Details

I. General information

NPI: 1942577861
Provider Name (Legal Business Name): LAZARO HARLEY MARTINEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 116
HIALEAH FL
33013-3825
US

IV. Provider business mailing address

7040 CORAL WAY APT 302
MIAMI FL
33155-1697
US

V. Phone/Fax

Practice location:
  • Phone: 305-835-0438
  • Fax: 305-693-0768
Mailing address:
  • Phone: 305-790-3163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: LAZARO HARLEY MARTINEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 305-790-3163