Healthcare Provider Details

I. General information

NPI: 1316635634
Provider Name (Legal Business Name): JOSE C MARTIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12905 SW 42ND ST STE 106
MIAMI FL
33175-2910
US

IV. Provider business mailing address

2400 SW 69TH AVE
MIAMI FL
33155-2919
US

V. Phone/Fax

Practice location:
  • Phone: 305-265-4441
  • Fax: 305-265-4844
Mailing address:
  • Phone: 305-265-4441
  • Fax: 305-265-4844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE CELESTINO MARTIN
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 305-265-4441