Healthcare Provider Details

I. General information

NPI: 1528351640
Provider Name (Legal Business Name): LAURA MARTIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST
MIAMI FL
33136-2137
US

IV. Provider business mailing address

1150 NW 14TH ST
MIAMI FL
33136-2137
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6090
  • Fax:
Mailing address:
  • Phone: 305-243-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberOS13445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: