Individual
IVAN DE JESUS MARTINEZ I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
8917 NW 178TH ST, HIALEAH, FL 33018-6554
(786) 348-9601
Mailing address
8917 NW 178TH ST, HIALEAH, FL 33018-6554
(786) 348-9601
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
MA45836
FL
Other
Enumeration date
10/29/2012
Last updated
10/29/2012
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