Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | ME126772 | FL |
NPI | 1295961712 |
---|---|
Provider Name | Dr. Stacey Martindale |
First Address | Aventura, FL 33180-1227 |
Second Address | Aventura, FL 33180-1227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 30/08/2016 |