Healthcare Provider Details

I. General information

NPI: 1588026850
Provider Name (Legal Business Name): PAULA GRAVINA MARTINEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA ROCHA GRAVINA MD

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 11/29/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W COPELAND DR 1ST FLOOR
ORLANDO FL
32806-2101
US

IV. Provider business mailing address

125 W COPELAND DR 1ST FLOOR
ORLANDO FL
32806-2101
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7090
  • Fax: 321-843-2267
Mailing address:
  • Phone: 321-841-7090
  • Fax: 321-843-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD478951
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME165137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: