Provider Demographics
NPI:1750388054
Name:MARTINEZ, GRACIELA A (MD)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 S JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-3716
Mailing Address - Country:US
Mailing Address - Phone:407-398-6470
Mailing Address - Fax:407-894-6872
Practice Address - Street 1:5900 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3716
Practice Address - Country:US
Practice Address - Phone:407-398-6470
Practice Address - Fax:407-894-6872
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2017-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0060897208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371426800Medicaid