Healthcare Provider Details

I. General information

NPI: 1558521195
Provider Name (Legal Business Name): ALBA T MARTINEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9210 SW 72ND ST. SUITE #101
MIAMI FL
33173-3274
US

IV. Provider business mailing address

9210 SW 72ND ST. SUITE #101
MIAMI FL
33173-3274
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-1000
  • Fax: 305-595-1977
Mailing address:
  • Phone: 305-595-1000
  • Fax: 305-595-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME95127
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME95127
License Number StateFL

VIII. Authorized Official

Name: DR. ALBA T MARTINEZ
Title or Position: MD/OWNER
Credential: MD
Phone: 305-595-1000