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Organization
ALLIED HEALTH PROVIDER LLC
Active
Organization
ALLIED HEALTH PROVIDER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA MARTINEZ PA-C (OWNER / PROVIDER)
(305) 989-7291
Entity
Organization
Contact information
Practice address
1625 NE 3RD CT, FORT LAUDERDALE, FL 33301-3808
(305) 989-7291
Mailing address
701 THREE ISLANDS BLVD STE 118, HALLANDALE BEACH, FL 33009-2822
(305) 989-7291
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9105777
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811266216
INDIVIDUAL NPI NUMBER
—
Enumeration date
05/07/2018
Last updated
05/07/2018
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