Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME115110 | FL |
Y | 111NI0900X | Internist | ME115110 | FL |
N | 207RA0401X | Internist - Addiction Medicine | ME115110 | FL |
NPI | 1003128828 |
---|---|
Provider Name | Ricardo Martinez |
First Address | Naples, FL 34102-5582 |
Second Address | Naples, FL 34102-5582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2010 |
Last Update Date | 24/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104729800 | (05) | FL |
207RA0401X | (05) | FL |
L1428 | MEDICARE (01) | FL |