Provider Demographics
NPI:1043704919
Name:FAJARDO MARTINEZ, KATIA (MD)
Entity type:Individual
Prefix:DR
First Name:KATIA
Middle Name:
Last Name:FAJARDO MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14652 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-3533
Mailing Address - Country:US
Mailing Address - Phone:786-469-1691
Mailing Address - Fax:
Practice Address - Street 1:2750 W 68TH ST STE 127-128
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5446
Practice Address - Country:US
Practice Address - Phone:305-558-0766
Practice Address - Fax:305-558-0766
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1096208D00000X
PR21030208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice