Provider Demographics
NPI:1851838494
Name:MARTINEZ PEREZ, MIGUEL ANTONIO (SA-C)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANTONIO
Last Name:MARTINEZ PEREZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6940 NW 186TH ST
Mailing Address - Street 2:APT 324
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3252
Mailing Address - Country:US
Mailing Address - Phone:786-315-8952
Mailing Address - Fax:
Practice Address - Street 1:6940 NW 186TH ST
Practice Address - Street 2:APT 324
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3252
Practice Address - Country:US
Practice Address - Phone:786-315-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16-682246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant