Healthcare Provider Details

I. General information

NPI: 1871884296
Provider Name (Legal Business Name): MANUEL MARTINEZ-MILLIAN MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6614 SW 114TH PL UNIT A
MIAMI FL
33173-1781
US

IV. Provider business mailing address

6614 SW 114TH PL UNIT A
MIAMI FL
33173-1781
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-1997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberMA43915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: