Provider Demographics
NPI:1932687316
Name:MARTINEZ LOPEZ, ROLANDO (NP-C)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:MARTINEZ LOPEZ
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 N KENDALL DR STE 306W
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2131
Mailing Address - Country:US
Mailing Address - Phone:305-549-8937
Mailing Address - Fax:786-801-0800
Practice Address - Street 1:8950 N KENDALL DR STE 306W
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2131
Practice Address - Country:US
Practice Address - Phone:305-596-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9415808363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101453400Medicaid