Provider Demographics
NPI:1801022421
Name:MARTINEZ, DANIEL ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERTO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 SW 87TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3635
Mailing Address - Country:US
Mailing Address - Phone:305-275-5525
Mailing Address - Fax:305-275-0662
Practice Address - Street 1:7600 SW 87TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3635
Practice Address - Country:US
Practice Address - Phone:305-275-5525
Practice Address - Fax:305-275-0662
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117540208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012201800Medicaid
FL14V1KOtherBLUE CROSS BLUE SHIELD
FL14V1KOtherBLUE CROSS BLUE SHIELD
FL012201800Medicaid