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General NPI Number Information
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NPI Number | 1992892558
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Entity Type | Organization
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Legal Business Name | AGUSTIN MARTINEZ M D P A
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 250 E 49TH ST
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City | HIALEAH
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State | FL
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Zip | 33013-1855
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Country | US
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Telephone | 305-822-6885
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Fax | 305-825-9965
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Provider Business Mailing Address
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Address Line | 1324 SW 143RD AVE
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City | MIAMI
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State | FL
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Zip | 33184-3223
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Country | US
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Telephone | 305-822-6885
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Fax | 305-825-9965
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Authorized Official
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Title or Position | PHYSICIAN
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Name | AGUSTIN MARTINEZ
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Credential | M.D.
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Telephone | 305-822-6885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME82266
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License Number State | FL
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