Healthcare Provider Details

I. General information

NPI: 1740887629
Provider Name (Legal Business Name): INGRID MARIA MARTINEZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6262 SUNSET DR STE 303
SOUTH MIAMI FL
33143-4843
US

IV. Provider business mailing address

18000 STUDEBAKER RD STE 800
CERRITOS CA
90703-2671
US

V. Phone/Fax

Practice location:
  • Phone: 786-663-5418
  • Fax:
Mailing address:
  • Phone: 562-735-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN9437588
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: