Provider Demographics
NPI:1992892558
Name:AGUSTIN MARTINEZ M D P A
Entity type:Organization
Organization Name:AGUSTIN MARTINEZ M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AGUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-822-6885
Mailing Address - Street 1:1324 SW 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3223
Mailing Address - Country:US
Mailing Address - Phone:305-822-6885
Mailing Address - Fax:305-825-9965
Practice Address - Street 1:250 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1855
Practice Address - Country:US
Practice Address - Phone:305-822-6885
Practice Address - Fax:305-825-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82266261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261107400Medicaid
FL261107400Medicaid
FLE5606Medicare ID - Type Unspecified