Provider Demographics
NPI:1912906355
Name:MARTINEZ, HUMBERTO SERGIO (CPH)
Entity Type:Individual
Prefix:MR
First Name:HUMBERTO
Middle Name:SERGIO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14217 SW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4316
Mailing Address - Country:US
Mailing Address - Phone:305-559-0638
Mailing Address - Fax:305-553-3511
Practice Address - Street 1:11865 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2400
Practice Address - Country:US
Practice Address - Phone:305-227-0023
Practice Address - Fax:305-227-3021
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist