Provider Demographics
NPI:1467764613
Name:DUBROVSKIY, RITCHELLE MARTINEZ (DO)
Entity Type:Individual
Prefix:
First Name:RITCHELLE
Middle Name:MARTINEZ
Last Name:DUBROVSKIY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RITCHELLE
Other - Middle Name:SUZANNE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-424-7000
Mailing Address - Fax:954-424-6003
Practice Address - Street 1:9611 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2334
Practice Address - Country:US
Practice Address - Phone:954-424-7000
Practice Address - Fax:954-424-6003
Is Sole Proprietor?:No
Enumeration Date:2010-07-04
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274346-130208000000X
FLOS12804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012132200Medicaid