Provider Demographics
NPI:1144594011
Name:MARTIR, ILEANA ROSE (MT)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:ROSE
Last Name:MARTIR
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 SW 130TH LANE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-5276
Mailing Address - Country:US
Mailing Address - Phone:787-604-8543
Mailing Address - Fax:
Practice Address - Street 1:7010 SW 130TH LANE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-5276
Practice Address - Country:US
Practice Address - Phone:787-604-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM636-416-79-721-0246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist