Organization
MILEDY MARTINEZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILEDY MARTINEZ (ADMINISTRATOR)
(813) 880-8393
Entity
Organization
Contact information
Practice address
6508 AMUNDSON CT, TAMPA, FL 33634-4731
(813) 880-8393
Mailing address
6508 AMUNDSON CT, TAMPA, FL 33634-4731
(813) 880-8393
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906029
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142775000
—
FL
Enumeration date
05/14/2015
Last updated
05/14/2015
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