Provider Demographics
NPI:1447417068
Name:MARTINEZ, NERISA EVA (LMT)
Entity Type:Individual
Prefix:MS
First Name:NERISA
Middle Name:EVA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 LUCERNE ST
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6672
Mailing Address - Country:US
Mailing Address - Phone:561-262-5511
Mailing Address - Fax:
Practice Address - Street 1:6121 LUCERNE ST
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6672
Practice Address - Country:US
Practice Address - Phone:561-262-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0012705174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC9004OtherBLUE CROSS