Individual
JORGE LUIS MARTINEZ BRUNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
216 FREDERICK ST, PIERSON, FL 32180-3024
(386) 202-6025
Mailing address
1205 S WOODLAND BLVD STE 3, DELAND, FL 32720-7464
(386) 202-6025
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123878600
—
FL
Enumeration date
07/30/2024
Last updated
12/11/2024
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