Healthcare Provider Details

I. General information

NPI: 1659699973
Provider Name (Legal Business Name): KIM MARTINEZ, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 W MCNAB RD #101
TAMARAC FL
33321-5351
US

IV. Provider business mailing address

7200 CORPORATE CENTER DR #600
MIAMI FL
33126-1200
US

V. Phone/Fax

Practice location:
  • Phone: 954-722-5600
  • Fax:
Mailing address:
  • Phone: 305-500-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberME87092
License Number StateFL

VIII. Authorized Official

Name: HOLLY LOPEZ
Title or Position: VP, SUPPORT SERVICES
Credential:
Phone: 305-500-2108