Provider Demographics
NPI:1548392236
Name:MARTINEZ, MARIANO M (MD)
Entity Type:Individual
Prefix:
First Name:MARIANO
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 NW 106TH CT
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-6638
Mailing Address - Country:US
Mailing Address - Phone:305-477-3572
Mailing Address - Fax:305-675-3714
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:305-477-3572
Practice Address - Fax:305-675-3714
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16,737207X00000X
FLACN294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004001200Medicaid
FL004001200Medicaid
FLU2050Medicare UPIN