Provider Demographics
NPI:1548677057
Name:RUBEN MARTINEZ MD PA
Entity type:Organization
Organization Name:RUBEN MARTINEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-366-0016
Mailing Address - Street 1:1984 ALAFAYA TRL STE 1002
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4524
Mailing Address - Country:US
Mailing Address - Phone:407-366-0016
Mailing Address - Fax:407-366-0015
Practice Address - Street 1:1984 ALAFAYA TRL STE 1002
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4524
Practice Address - Country:US
Practice Address - Phone:407-366-0016
Practice Address - Fax:407-366-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110904174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty