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General NPI Number Information
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NPI Number | 1780957910
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Entity Type | Individual
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Provider Name | JUREK MARTINEZ LMT
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Gender | Male
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Dates
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Enumeration Date | 02/19/2012
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 3900 NW 79TH AVE SUITE 476A
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City | DORAL
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State | FL
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Zip | 33166-6556
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Country | US
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Telephone | 786-395-5545
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 NW 79TH AVE SUITE 476A
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City | DORAL
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State | FL
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Zip | 33166-6556
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Country | US
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Telephone | 786-395-5545
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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 | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60762
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License Number State | FL
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