Provider Demographics
NPI:1043414410
Name:COLON-MARTINEZ, MIRYLSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRYLSA
Middle Name:
Last Name:COLON-MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9970 CENTRAL PARK BLVD N STE 402
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2236
Mailing Address - Country:US
Mailing Address - Phone:954-251-6051
Mailing Address - Fax:954-653-7207
Practice Address - Street 1:9970 CENTRAL PARK BLVD N STE 402
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428
Practice Address - Country:US
Practice Address - Phone:954-251-6051
Practice Address - Fax:954-653-7207
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124264207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015543400Medicaid
FLCM429ZMedicare PIN