Provider Demographics
NPI:1689053324
Name:CHOICE ONE MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CHOICE ONE MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-389-9568
Mailing Address - Street 1:49 N FEDERAL HWY
Mailing Address - Street 2:STE 135
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4304
Mailing Address - Country:US
Mailing Address - Phone:954-703-6065
Mailing Address - Fax:888-972-1875
Practice Address - Street 1:9730 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2311
Practice Address - Country:US
Practice Address - Phone:305-758-7979
Practice Address - Fax:305-758-0034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICE ONE MEDICAL ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 58497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty