Provider Demographics
NPI:1023667680
Name:MARTI PINEDA, JOHANA ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:JOHANA
Middle Name:ELIZABETH
Last Name:MARTI PINEDA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6261 SW 24TH PL APT 108
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1159
Mailing Address - Country:US
Mailing Address - Phone:754-207-7608
Mailing Address - Fax:
Practice Address - Street 1:4900 W OAKLAND PARK BLVD STE 207
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1501
Practice Address - Country:US
Practice Address - Phone:954-735-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine