Provider Demographics
NPI:1306131040
Name:ISIDRO R. MARTINEZ MD LLC
Entity type:Organization
Organization Name:ISIDRO R. MARTINEZ MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISIDRO
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-866-8448
Mailing Address - Street 1:7153 VIA FIRENZE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1044
Mailing Address - Country:US
Mailing Address - Phone:561-866-8448
Mailing Address - Fax:561-392-3402
Practice Address - Street 1:7153 VIA FIRENZE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-1044
Practice Address - Country:US
Practice Address - Phone:561-866-8448
Practice Address - Fax:561-392-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94896207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74327200Medicaid
FL74327200Medicaid
FL34070ZMedicare PIN