Provider Demographics
NPI:1124328778
Name:MARTINEZ, VICTOR MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 SW 117TH AVE STE C203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2156
Mailing Address - Country:US
Mailing Address - Phone:305-598-6696
Mailing Address - Fax:305-598-7491
Practice Address - Street 1:8900 SW 117TH AVE STE C203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2156
Practice Address - Country:US
Practice Address - Phone:305-598-6696
Practice Address - Fax:305-598-7491
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81463261QP2300X
FL81463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81463OtherME