Basic Information
| Provider Information | |||||||||
| NPI: | 1922008226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | FELIPE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 SW 57TH AVE | ||||||||
| Address2: | # 210 | ||||||||
| City: | WEST MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331445775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054410744 | ||||||||
| FaxNumber: | 3052628771 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 SW 57TH AVE | ||||||||
| Address2: | # 210 | ||||||||
| City: | WEST MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331445775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054410744 | ||||||||
| FaxNumber: | 3052628771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | ME37031 | FL | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 069998500 | 05 | FL | MEDICAID |