Provider Demographics
NPI:1013946458
Name:MARTINEZ, REBECA CARIDAD (MD)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:CARIDAD
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:C
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3659 S MIAMI AVE
Mailing Address - Street 2:SUITE 4006
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4227
Mailing Address - Country:US
Mailing Address - Phone:305-534-8005
Mailing Address - Fax:305-532-7826
Practice Address - Street 1:3659 S MIAMI AVE
Practice Address - Street 2:SUITE 4006
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4227
Practice Address - Country:US
Practice Address - Phone:305-534-8005
Practice Address - Fax:305-532-7826
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54659207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201600506OtherTAX ID
FL02077OtherBCBS
FL208792OtherAVMED
FL201600506OtherTAX ID
FL208792OtherAVMED