Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME55114 | FL |
Y | 2080P0204X | Pediatric Emergency Doctor | ME5514 | FL |
NPI | 1295870590 |
---|---|
Provider Name | Nestor J Martinez |
First Address | Pembroke Pines, FL 33029-3347 |
Second Address | Pembroke Pines, FL 33029-3347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
257287700 | (05) | FL |