Provider Demographics
NPI:1912985789
Name:MARTINEZ, ENERCIDA (MD)
Entity type:Individual
Prefix:DR
First Name:ENERCIDA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:4090 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4501
Practice Address - Country:US
Practice Address - Phone:386-761-0050
Practice Address - Fax:386-761-1167
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15802146D00000X
FLACN909208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23050MAOtherTRIPLE-S PROVIDER NUMBER
PRI28942Medicare UPIN
PR23050MAOtherTRIPLE-S PROVIDER NUMBER