Provider Demographics
NPI:1013985803
Name:MARTINEZ-REYES, GUILLERMO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:A
Last Name:MARTINEZ-REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GUILLERMO
Other - Middle Name:A
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5975 SUNSET DR STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5198
Mailing Address - Country:US
Mailing Address - Phone:305-661-8040
Mailing Address - Fax:305-661-8891
Practice Address - Street 1:5975 SUNSET DR STE 405
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5198
Practice Address - Country:US
Practice Address - Phone:305-661-8040
Practice Address - Fax:305-661-8891
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFM2169856OtherDEA
FLFM2169856OtherDEA
FL96083ZMedicare PIN