Provider Demographics
NPI:1760571715
Name:MARTINEZ, JUDITH (MA 42435)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA 42435
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 NW SOUTH TAMIAMI CANAL DR # DR.305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1483
Mailing Address - Country:US
Mailing Address - Phone:305-244-8365
Mailing Address - Fax:305-444-6969
Practice Address - Street 1:4275 NW SOUTH TAMIAMI CANAL DR # 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1483
Practice Address - Country:US
Practice Address - Phone:305-244-8365
Practice Address - Fax:305-444-6969
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 42435261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility