Provider Demographics
NPI:1174823751
Name:JUVENAL E MARTINEZ MD PA
Entity Type:Organization
Organization Name:JUVENAL E MARTINEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUVENAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-598-6696
Mailing Address - Street 1:8900 SW 117TH AVE
Mailing Address - Street 2:SUITE C203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2175
Mailing Address - Country:US
Mailing Address - Phone:305-598-6696
Mailing Address - Fax:305-598-7491
Practice Address - Street 1:8900 SW 117TH AVE
Practice Address - Street 2:SUITE C203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2175
Practice Address - Country:US
Practice Address - Phone:305-598-6696
Practice Address - Fax:305-598-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40592261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58894Medicare UPIN