Healthcare Provider Details

I. General information

NPI: 1457181869
Provider Name (Legal Business Name): CRISTINA MARTINE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 10TH AVE N STE 401
LAKE WORTH FL
33461-6609
US

IV. Provider business mailing address

950 NW 20TH ST
MIAMI FL
33127-4622
US

V. Phone/Fax

Practice location:
  • Phone: 561-284-8455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberPA9119177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: