Healthcare Provider Details

I. General information

NPI: 1619963287
Provider Name (Legal Business Name): JUAN CARLOS MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT STE 203
MIAMI FL
33155-4070
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8380
  • Fax: 866-832-5324
Mailing address:
  • Phone: 305-661-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME68828
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: