=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174827117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSE MARTINEZ-ALBA JR MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2011
-----------------------------------------------------
Last Update Date | 11/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7100 W 20TH AVE SUITE 514
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-1824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-556-2255
-----------------------------------------------------
Fax | 305-821-7958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7100 W 20TH AVE SUITE 514
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-1824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-556-2255
-----------------------------------------------------
Fax | 305-821-7958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSE R MARTINEZ-ALBA JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-556-2255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | ME55751
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------