Provider Demographics
NPI:1790857118
Name:MARTINEZ, YADIRA L (MD)
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YADIRA
Other - Middle Name:L
Other - Last Name:MARTINEZ-FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:ACB 2ND FL CARDIOLOGY MIAMI CHILDRENS CARDIOLOGY
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:786-624-3694
Mailing Address - Fax:305-669-6418
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:ACB 2ND FL CARDIOLOGY
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:786-624-3694
Practice Address - Fax:305-669-6418
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME872182080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651100240OtherTAX ID