Healthcare Provider Details

I. General information

NPI: 1316391709
Provider Name (Legal Business Name): DAYANA R MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 W 76TH ST UNIT 1
HIALEAH FL
33016-1834
US

IV. Provider business mailing address

2075 W 76TH ST UNIT 1
HIALEAH FL
33016-1834
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-3577
  • Fax: 305-456-3574
Mailing address:
  • Phone: 305-456-3577
  • Fax: 305-456-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: