Provider Demographics
NPI:1245256924
Name:MARTINEZ, LEON A (MD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-245-0200
Mailing Address - Fax:305-245-6186
Practice Address - Street 1:692 N HOMESTEAD BLVD STE 102
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6236
Practice Address - Country:US
Practice Address - Phone:786-243-5900
Practice Address - Fax:855-451-2158
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL91193207Q00000X
FLME91193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277093800Medicaid
FLI26236Medicare UPIN
FLU4333Medicare PIN