Provider Demographics
NPI:1881323913
Name:MARTINEZ ARENAS, JUAN ERNESTO
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ERNESTO
Last Name:MARTINEZ ARENAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4872 NW 97TH PL
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1988
Mailing Address - Country:US
Mailing Address - Phone:786-598-6855
Mailing Address - Fax:
Practice Address - Street 1:790 NW 107TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3100
Practice Address - Country:US
Practice Address - Phone:305-964-5426
Practice Address - Fax:305-964-5627
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM635-425-93-269-0OtherLICENCE FLORIDA