Provider Demographics
NPI:1225113590
Name:MARTINEZ, STELLA G (CRNA)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:G
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-1054
Mailing Address - Country:US
Mailing Address - Phone:305-835-4475
Mailing Address - Fax:305-835-4388
Practice Address - Street 1:651 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3814
Practice Address - Country:US
Practice Address - Phone:305-835-4475
Practice Address - Fax:305-835-4388
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP948842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist