Basic Information
| Provider Information | |||||||||
| NPI: | 1043682826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA MARTINEZ | ||||||||
| FirstName: | IVAN | ||||||||
| MiddleName: | RAFAEL | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 E 23RD ST APT 407 | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330133935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863623543 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5378 W 16TH AVE | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330122165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058204101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2015 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN 9370031 | FL | N | Nursing Service Providers | Registered Nurse | 363LF0000X | ARNP 9370031 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.