Healthcare Provider Details

I. General information

NPI: 1154524379
Provider Name (Legal Business Name): DEBORAH ANN MARTINEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 W VINE ST
KISSIMMEE FL
34741-3738
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 407-569-1260
  • Fax: 833-963-0109
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: