Provider Demographics
NPI:1073794178
Name:PETER A. MARTINEZ NODA, D.O., P.A.
Entity Type:Organization
Organization Name:PETER A. MARTINEZ NODA, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:MARTINEZ NODA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-273-4454
Mailing Address - Street 1:7000 SW 97TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1474
Mailing Address - Country:US
Mailing Address - Phone:305-273-4454
Mailing Address - Fax:
Practice Address - Street 1:7000 SW 97TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1474
Practice Address - Country:US
Practice Address - Phone:305-273-4454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S00062542080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty