Provider Demographics
NPI:1306590898
Name:MARTIN, ALFREDO (RN BSN)
Entity type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 GRAND CANAL DR STE 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2569
Mailing Address - Country:US
Mailing Address - Phone:786-803-8002
Mailing Address - Fax:305-264-2909
Practice Address - Street 1:85 GRAND CANAL DR STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2569
Practice Address - Country:US
Practice Address - Phone:786-803-8002
Practice Address - Fax:305-264-2909
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9424246163W00000X
FL147214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No163W00000XNursing Service ProvidersRegistered Nurse