Provider Demographics
NPI:1700347838
Name:MARTINEZ, RAFAEL
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SW 27TH AVENUE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4749
Mailing Address - Country:US
Mailing Address - Phone:786-953-7482
Mailing Address - Fax:786-953-7467
Practice Address - Street 1:1250 SW 27TH AVENUE
Practice Address - Street 2:SUITE 306
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4749
Practice Address - Country:US
Practice Address - Phone:786-953-7482
Practice Address - Fax:786-953-7467
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001994363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily