Provider Demographics
NPI:1821411745
Name:MARTINEZ, LINDA (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 NW 79TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:305-552-7660
Mailing Address - Fax:305-552-7662
Practice Address - Street 1:3901 NW 79TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6508
Practice Address - Country:US
Practice Address - Phone:305-552-7660
Practice Address - Fax:305-552-7662
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125615208000000X, 208D00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice