Healthcare Provider Details

I. General information

NPI: 1013380609
Provider Name (Legal Business Name): CARLOS LUIS MARTINEZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 SW 117TH AVE STE 304
MIAMI FL
33183-4826
US

IV. Provider business mailing address

1461 SHORE PKWY APT 7C
BROOKLYN NY
11214-6126
US

V. Phone/Fax

Practice location:
  • Phone: 305-204-1201
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME150252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: