Provider Demographics
NPI:1346875622
Name:MARTINEZ, ALEXIS (APRN)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8324 NW 142ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5750
Mailing Address - Country:US
Mailing Address - Phone:305-793-8839
Mailing Address - Fax:
Practice Address - Street 1:8324 NW 142ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5750
Practice Address - Country:US
Practice Address - Phone:305-793-8839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9295541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine