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General NPI Number Information
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NPI Number | 1033404272
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Entity Type | Organization
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Legal Business Name | MARTINA AUDIOLOGY AND HEARING SERVICES, LLC
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 15271 MCGREGOR BLVD SUITE 17
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City | FORT MYERS
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State | FL
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Zip | 33908-1908
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Country | US
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Telephone | 239-433-2060
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Fax | 239-433-0925
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Provider Business Mailing Address
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Address Line | 15271 MCGREGOR BLVD SUITE 17
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City | FORT MYERS
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State | FL
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Zip | 33908-1908
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Country | US
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Telephone | 239-433-2060
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Fax | 239-433-0925
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK MARTINA
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Credential |
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Telephone | 239-433-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | AY103
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License Number State | FL
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