Healthcare Provider Details

I. General information

NPI: 1760571715
Provider Name (Legal Business Name): JUDITH MARTINEZ MA 42435
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 NW SOUTH TAMIAMI CANAL DR # 305
MIAMI FL
33126-1483
US

IV. Provider business mailing address

4275 NW SOUTH TAMIAMI CANAL DR # DR.305
MIAMI FL
33126-1483
US

V. Phone/Fax

Practice location:
  • Phone: 305-244-8365
  • Fax: 305-444-6969
Mailing address:
  • Phone: 305-244-8365
  • Fax: 305-444-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberMA 42435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: