Provider Demographics
NPI:1851044259
Name:MARTINEZ RODRIGUEZ, MARI DELMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARI
Middle Name:DELMAR
Last Name:MARTINEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:DELMAR
Other - Last Name:MARTINEZ RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8367 LAKE WAVERLY LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7655
Mailing Address - Country:US
Mailing Address - Phone:407-580-9653
Mailing Address - Fax:
Practice Address - Street 1:8367 LAKE WAVERLY LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-7655
Practice Address - Country:US
Practice Address - Phone:407-580-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23307208D00000X
PR16081390200000X
FLACN1541208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1Medicaid