Provider Demographics
NPI:1578187126
Name:MARTINEZ, HELMUTH IVAN (SA-C)
Entity Type:Individual
Prefix:
First Name:HELMUTH
Middle Name:IVAN
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14829 SW 80TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1521
Mailing Address - Country:US
Mailing Address - Phone:786-770-2014
Mailing Address - Fax:
Practice Address - Street 1:14829 SW 80TH ST APT 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1521
Practice Address - Country:US
Practice Address - Phone:786-770-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20-253246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant