Healthcare Provider Details

I. General information

NPI: 1275666737
Provider Name (Legal Business Name): BERTA MARTINEZ-FORTUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 SW 81ST AVE
MIAMI FL
33155-2561
US

IV. Provider business mailing address

2720 SW 81ST AVE
MIAMI FL
33155-2561
US

V. Phone/Fax

Practice location:
  • Phone: 305-979-5489
  • Fax:
Mailing address:
  • Phone: 305-979-5489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103057
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME175325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: