Healthcare Provider Details

I. General information

NPI: 1043120256
Provider Name (Legal Business Name): LUIS ORLANDO MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 NW NORTH RIVER DR APT 1804
MIAMI FL
33125-2876
US

IV. Provider business mailing address

1480 NW NORTH RIVER DR APT 1804
MIAMI FL
33125-2876
US

V. Phone/Fax

Practice location:
  • Phone: 786-777-8937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11050666
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: