Healthcare Provider Details

I. General information

NPI: 1912503582
Provider Name (Legal Business Name): ILSYS MARTINEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 NW 7TH ST STE 150
MIAMI FL
33126-2941
US

IV. Provider business mailing address

10580 SW 160TH CT
MIAMI FL
33196-3181
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-2929
  • Fax: 786-558-0242
Mailing address:
  • Phone: 305-338-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: