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General NPI Number Information
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NPI Number | 1407611304
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Entity Type | Individual
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Provider Name | MR. JOSE ALEJANDRO MARTINEZ VALLEJO
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Gender | Male
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 7020 BAYFRONT SCENIC DR UNIT 1325
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City | ORLANDO
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State | FL
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Zip | 32819-2208
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Country | US
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Telephone | 689-837-5289
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Fax |
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Provider Business Mailing Address
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Address Line | 7020 BAYFRONT SCENIC DR UNIT 1325
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City | ORLANDO
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State | FL
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Zip | 32819-2208
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Country | US
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Telephone | 689-837-5289
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 24-122
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License Number State | WI
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