MEDICARE: GUSTAVO A MARTINEZ

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	122300000X	Dentist	21727	FL

General Provider Information

NPI Number	:	1831558964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO A MARTINEZ

Provider Business Mailing Address
First Line	:	3559 S FEDERAL HWY APT D
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-8696
Country	:	US
Telephone Number	:	786-389-1709
Fax Number	:

Provider Business Practice Location Address
First Line	:	3559 S FEDERAL HWY APT D
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-8696
Country	:	US
Telephone Number	:	786-389-1709
Fax Number	:

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

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	02/17/2016

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Directions to “ GUSTAVO A MARTINEZ ” Practice Location

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