1306870977 NPI number — DR. GLADYS R MARTINEZ DO

Table of content: DR. GLADYS R MARTINEZ DO (NPI 1306870977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306870977 NPI number — DR. GLADYS R MARTINEZ DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
GLADYS
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306870977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15340 JOG RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33446-2170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-819-6700
Provider Business Mailing Address Fax Number:
561-819-6701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15340 JOG RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33446-2170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-819-6700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS7477 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4304693 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55126 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 56-2547040 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: F94431I413 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: F94431I413 . This is a "SUMMIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4573393 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 305705 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 56-2547040 . This is a "HEALTH CARE DISTRICT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56-2547040 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 650561267 . This is a "TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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