Provider Demographics
NPI:1023844008
Name:MARTINEZ, ANDRES (PA)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:DR
Other - First Name:ANDRES
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:175 NE 203RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33179-6003
Mailing Address - Country:US
Mailing Address - Phone:786-315-0567
Mailing Address - Fax:
Practice Address - Street 1:4801 HOLLYWOOD BLVD STE B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6545
Practice Address - Country:US
Practice Address - Phone:954-927-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant