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General NPI Number Information
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NPI Number | 1285987057
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Entity Type | Organization
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Legal Business Name | JOSE L. MARTINEZ MD PA
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 11653 SOUTH BREEZE PL
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City | WELLINGTON
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State | FL
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Zip | 33449
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Country | US
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Telephone | 561-602-4564
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Fax |
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Provider Business Mailing Address
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Address Line | 3319 STATE ROAD 7 STE 215
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City | WELLINGTON
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State | FL
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Zip | 33449-8092
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Country | US
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Telephone | 561-791-1630
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Fax | 561-791-0595
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE LUCIANO MARTINEZ
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Credential | MD
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Telephone | 561-791-1630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0056575
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License Number State | FL
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