Provider Demographics
NPI:1528506276
Name:MARTINEZ, IVAN (RPT, CPHT)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:RPT, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5175
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-1175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3650 NW 36TH ST
Practice Address - Street 2:APT 208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-4912
Practice Address - Country:US
Practice Address - Phone:954-470-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT 50610183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician