| Doctor Name: | IVAN DE JESUS MARTINEZ |
| NPI Number: | 1629322649 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.M.T. |
| License Number: | MA45836 |
| Business Practice Address: | 8917 Nw 178th St Hialeah, FL - 330186554 |
| Business Phone Number: | 7863489601 |
| Business Fax Number: | |
| Mailing Address: | 8917 Nw 178th St, HIALEAH |
| State: | FL |
| Postal Code: | 330186554 |
| Phone Number: | 7863489601 |
| Fax Number: | |
| NPI Enumeration Date: | 10/29/2012 |
| NPI Last Update Date: | 10/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | MA45836 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |