Provider Demographics
NPI:1487071817
Name:TERESA MARTINEZ,M.D.,PA
Entity type:Organization
Organization Name:TERESA MARTINEZ,M.D.,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-218-4128
Mailing Address - Street 1:7811 SW 24TH ST STE 137
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6540
Mailing Address - Country:US
Mailing Address - Phone:305-446-3534
Mailing Address - Fax:786-363-1179
Practice Address - Street 1:7811 SW 24TH ST STE 137
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6540
Practice Address - Country:US
Practice Address - Phone:305-446-3534
Practice Address - Fax:786-363-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061791100Medicaid
FLE20109Medicare UPIN
FL061791100Medicaid