Basic Information
| Provider Information | |||||||||
| NPI: | 1295106193 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ NOA | ||||||||
| FirstName: | JORGE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3506 SW 91ST AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331654359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053000426 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11880 BIRD RD | ||||||||
| Address2: | SUITE 416 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331753584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052270604 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2015 | ||||||||
| LastUpdateDate: | 10/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | ARNP9334007 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.