Healthcare Provider Details

I. General information

NPI: 1255248571
Provider Name (Legal Business Name): IDEL MEDICAL RESEARCH GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 PALMETTO FRNTG RD STE 107
MIAMI LAKES FL
33016-1568
US

IV. Provider business mailing address

14100 PALMETTO FRNTG RD STE 107
MIAMI LAKES FL
33016-1568
US

V. Phone/Fax

Practice location:
  • Phone: 305-488-4591
  • Fax: 305-488-0438
Mailing address:
  • Phone: 305-488-4591
  • Fax: 305-488-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DIANELYS MARTINEZ
Title or Position: OWNER
Credential: APRN
Phone: 305-488-4591