Healthcare Provider Details

I. General information

NPI: 1104289107
Provider Name (Legal Business Name): JULIO FERNANDO MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

IV. Provider business mailing address

2127 LYRIC AVE
LOS ANGELES CA
90027-4753
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1264
  • Fax:
Mailing address:
  • Phone: 323-397-5869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1026728
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: