Provider Demographics
NPI:1104056225
Name:PEARSON-MARTINEZ, MIRIAM (LM)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:PEARSON-MARTINEZ
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 N. SWINTON AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444
Mailing Address - Country:US
Mailing Address - Phone:561-674-2060
Mailing Address - Fax:561-952-0856
Practice Address - Street 1:353 N. SWINTON AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444
Practice Address - Country:US
Practice Address - Phone:561-674-2060
Practice Address - Fax:561-952-0856
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW167176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340429300Medicaid