Provider Demographics
NPI:1154611846
Name:MARTINEZ, GERARDO (DC)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 N KENDALL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1216
Mailing Address - Country:US
Mailing Address - Phone:786-953-8667
Mailing Address - Fax:786-953-8717
Practice Address - Street 1:11010 N KENDALL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1216
Practice Address - Country:US
Practice Address - Phone:786-953-8667
Practice Address - Fax:786-953-8717
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFN986ZMedicare UPIN