Healthcare Provider Details

I. General information

NPI: 1053675579
Provider Name (Legal Business Name): MAYLIN MARTINEZ BADOSA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12515 SW 88TH ST
MIAMI FL
33186-1829
US

IV. Provider business mailing address

6100 BLUE LAGOON DR SUITE 365
MIAMI FL
33126-2079
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-5366
  • Fax: 305-644-6407
Mailing address:
  • Phone: 786-322-7333
  • Fax: 786-322-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME123333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: