Provider Demographics
NPI:1558459529
Name:MARTINEZ, JUVENAL EUGENIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUVENAL
Middle Name:EUGENIO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8900 SW 117TH AVE
Mailing Address - Street 2:SUITE C203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2175
Mailing Address - Country:US
Mailing Address - Phone:305-598-6696
Mailing Address - Fax:305-598-7491
Practice Address - Street 1:8900 SW 117TH AVE
Practice Address - Street 2:SUITE C203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2175
Practice Address - Country:US
Practice Address - Phone:305-598-6696
Practice Address - Fax:305-598-7491
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL40592207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58894Medicare UPIN