Provider Demographics
NPI:1184841835
Name:VALDIVIA ARENAS, MARTIN ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ALEXANDER
Last Name:VALDIVIA ARENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2123
Mailing Address - Country:US
Mailing Address - Phone:419-429-6441
Mailing Address - Fax:419-429-6437
Practice Address - Street 1:914 MARINA DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-2123
Practice Address - Country:US
Practice Address - Phone:419-429-6441
Practice Address - Fax:419-429-6437
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124311207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2770783Medicaid
OHP00472604OtherRAILROAD CARE
OHP00641171OtherRAILROAD CARE
OH2770783Medicaid
OHP00472604OtherRAILROAD CARE