Provider Demographics
NPI:1174827117
Name:JOSE MARTINEZ-ALBA JR MD PA
Entity Type:Organization
Organization Name:JOSE MARTINEZ-ALBA JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTINEZ-ALBA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-556-2255
Mailing Address - Street 1:7100 W 20TH AVE
Mailing Address - Street 2:SUITE 514
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1824
Mailing Address - Country:US
Mailing Address - Phone:305-556-2255
Mailing Address - Fax:305-821-7958
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:SUITE 514
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1824
Practice Address - Country:US
Practice Address - Phone:305-556-2255
Practice Address - Fax:305-821-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty