1407378516 NPI number — KRISTA MICHELLE MARTINEZ RT

Table of content: DEEMA B AKARI M.D (NPI 1154984482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407378516 NPI number — KRISTA MICHELLE MARTINEZ RT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
KRISTA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOORE
Provider Other First Name:
KRISTA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407378516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4664 NW 114TH AVE APT 504
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33178-4822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-425-2199
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 NW 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33125-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-575-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2017

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: 2471C3402X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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