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General NPI Number Information
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NPI Number | 1770463598
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Entity Type | Individual
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Provider Name | MIGUEL MARTINEZ GONZALEZ
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Gender | Male
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 5220 N 43RD AVE APT 213
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City | GLENDALE
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State | AZ
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Zip | 85301-7135
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Country | US
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Telephone | 480-876-5866
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Fax |
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Provider Business Mailing Address
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Address Line | 1160 W 64TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-6418
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Country | US
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Telephone | 786-443-3762
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10336
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License Number State | AZ
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