Healthcare Provider Details

I. General information

NPI: 1346154804
Provider Name (Legal Business Name): PORT SAINT LUCIE INFECTIOUS DISEASES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SE OCEAN BLVD STE A
STUART FL
34994-2448
US

IV. Provider business mailing address

800 SE OCEAN BLVD STE A
STUART FL
34994-2448
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-0423
  • Fax: 216-548-4735
Mailing address:
  • Phone: 216-778-0423
  • Fax: 216-548-4735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. OSCAR I. MARTINEZ LOPEZ
Title or Position: OWNER
Credential: MD
Phone: 216-778-0423