Healthcare Provider Details

I. General information

NPI: 1093822041
Provider Name (Legal Business Name): JUAN B MARTINEZ JR. M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 N COMMERCE PKWY STE 2
WESTON FL
33326-3252
US

IV. Provider business mailing address

2233 N COMMERCE PKWY STE 2
WESTON FL
33326-3252
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-0333
  • Fax: 954-659-0999
Mailing address:
  • Phone: 954-659-0333
  • Fax: 954-659-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0073596
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: