MEDICARE: SANDRA MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1386095651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MARTIN

Provider Business Mailing Address
First Line	:	PO BOX 260303
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33026-7303
Country	:	US
Telephone Number	:	954-451-8956
Fax Number	:

Provider Business Practice Location Address
First Line	:	3556 SW 90TH AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-7635
Country	:	US
Telephone Number	:	954-451-8956
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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Directions to “ SANDRA MARTIN ” Practice Location

Language	Start Address	Practice Location

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