Healthcare Provider Details

I. General information

NPI: 1497271209
Provider Name (Legal Business Name): MR. ANGEL A MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 NW 2ND ST UNIT 104
POMPANO BEACH FL
33069
US

IV. Provider business mailing address

3235 NW 2ND ST APT 104
POMPANO BEACH FL
33069-2646
US

V. Phone/Fax

Practice location:
  • Phone: 954-864-4855
  • Fax:
Mailing address:
  • Phone: 954-864-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: