Basic Information
| Provider Information | |||||||||
| NPI: | 1962771386 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | LEANDRO | ||||||||
| MiddleName: | ARIEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1484 AVON LN | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NORTH LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330685584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6463587059 | ||||||||
| FaxNumber: | 8014637341 | ||||||||
| Practice Location | |||||||||
| Address1: | 144 S 500 E | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841021907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6463587059 | ||||||||
| FaxNumber: | 8014637341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2011 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME115017 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 9045511-1205 | UT | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.