Healthcare Provider Details

I. General information

NPI: 1578990438
Provider Name (Legal Business Name): RAFAEL MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CYPRESS PKWY
KISSIMMEE FL
34759-3328
US

IV. Provider business mailing address

1050 CYPRESS PKWY
KISSIMMEE FL
34759-3328
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-1400
  • Fax: 407-483-1405
Mailing address:
  • Phone: 407-483-1400
  • Fax: 407-483-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number018814
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberANC889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: