Provider Demographics
NPI:1437144219
Name:PERNAS, MARTHA BEATRIZ (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:BEATRIZ
Last Name:PERNAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:975 BAPTIST WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7600
Mailing Address - Country:US
Mailing Address - Phone:305-245-4549
Mailing Address - Fax:305-245-4590
Practice Address - Street 1:975 BAPTIST WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7600
Practice Address - Country:US
Practice Address - Phone:305-245-4549
Practice Address - Fax:305-245-4590
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2013-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME87374208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270115400Medicaid