Healthcare Provider Details

I. General information

NPI: 1710791280
Provider Name (Legal Business Name): SKYLINE MEDICAL ASSOCIATES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9495 SW 72ND ST STE B250
MIAMI FL
33173-5411
US

IV. Provider business mailing address

3420 SW 124TH CT
MIAMI FL
33175-2952
US

V. Phone/Fax

Practice location:
  • Phone: 786-613-1151
  • Fax: 567-706-2773
Mailing address:
  • Phone: 786-613-1151
  • Fax: 567-706-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PEDRO SAN MARTIN
Title or Position: OWNER
Credential: MD
Phone: 786-613-1151