Healthcare Provider Details

I. General information

NPI: 1861429425
Provider Name (Legal Business Name): JOSE CELESTINO MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 CORAL WAY
MIAMI FL
33155-1758
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: 305-726-4377
Mailing address:
  • Phone: 305-265-4441
  • Fax: 305-735-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME35511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: