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General NPI Number Information
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NPI Number | 1275812901
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Entity Type | Individual
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Provider Name | MARTITA MARCANO PEREZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 916 DUNDEE RD
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City | DUNDEE
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State | FL
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Zip | 33838-4198
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Country | US
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Telephone | 866-234-8534
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Fax |
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Provider Business Mailing Address
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Address Line | 47 5TH ST NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4672
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Country | US
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Telephone | 866-234-8534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 019028
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME156214
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 019028
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME156214
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License Number State | FL
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