Provider Demographics
NPI:1083287296
Name:MARTINEZ ORTEGA, JOSE HERNAN
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:HERNAN
Last Name:MARTINEZ ORTEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4676 GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2144
Mailing Address - Country:US
Mailing Address - Phone:305-562-6978
Mailing Address - Fax:
Practice Address - Street 1:4676 GREENWAY DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2144
Practice Address - Country:US
Practice Address - Phone:305-562-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013205363LP0200X
FL11013205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty