Basic Information
| Provider Information | |||||||||
| NPI: | 1003103508 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PM&R MIREDA MARTINEZ SANCHEZ, MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1361 SE 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330352207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873564544 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2525 SW 75TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331552800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052601852 | ||||||||
| FaxNumber: | 3052654824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 01/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ-SANCHEZ | ||||||||
| AuthorizedOfficialFirstName: | MIREDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7873564544 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | ME101065 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.