Provider Demographics
NPI:1346625811
Name:DIAZ SALAZAR, MARTHA (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:DIAZ SALAZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 BLUE LAGOON DR STE 365
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-7010
Mailing Address - Country:US
Mailing Address - Phone:786-322-7333
Mailing Address - Fax:786-347-5022
Practice Address - Street 1:751 W PALM DR
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-3223
Practice Address - Country:US
Practice Address - Phone:786-377-0120
Practice Address - Fax:305-248-6106
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31592207Q00000X
FLME129747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021515800Medicaid