Provider Demographics
NPI:1619415692
Name:MARTINEZ, JOSE OMAR
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:OMAR
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 S FEDERAL HWY APT A
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-8823
Mailing Address - Country:US
Mailing Address - Phone:787-454-5696
Mailing Address - Fax:
Practice Address - Street 1:2624 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM
Practice Address - State:FL
Practice Address - Zip Code:33406
Practice Address - Country:US
Practice Address - Phone:787-454-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor