Healthcare Provider Details

I. General information

NPI: 1760405203
Provider Name (Legal Business Name): SANTIAGO MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 W MICHIGAN ST
ORLANDO FL
32806-4453
US

IV. Provider business mailing address

5929 BALCONES DR STE 200
AUSTIN TX
78731-4280
US

V. Phone/Fax

Practice location:
  • Phone: 407-422-4921
  • Fax: 407-644-5445
Mailing address:
  • Phone: 512-550-1800
  • Fax: 512-233-5338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME57308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: