Provider Demographics
NPI:1861429425
Name:MARTIN, JOSE CELESTINO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:CELESTINO
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2919
Mailing Address - Country:US
Mailing Address - Phone:305-265-4441
Mailing Address - Fax:305-735-2276
Practice Address - Street 1:6850 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1758
Practice Address - Country:US
Practice Address - Phone:305-265-4441
Practice Address - Fax:305-726-4377
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35511207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065557100Medicaid
FL95712Medicare ID - Type Unspecified
FL065557100Medicaid