Healthcare Provider Details

I. General information

NPI: 1023844008
Provider Name (Legal Business Name): ANDRES MARTINEZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANDRES MARTINEZ PA

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 HOLLYWOOD BLVD STE B
HOLLYWOOD FL
33021-6545
US

IV. Provider business mailing address

175 NE 203RD TER
MIAMI GARDENS FL
33179-6003
US

V. Phone/Fax

Practice location:
  • Phone: 954-927-5905
  • Fax:
Mailing address:
  • Phone: 786-315-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001088
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: