Provider Demographics
NPI:1447527254
Name:DOTRES MARTINEZ, MARITZA (MD)
Entity type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:DOTRES MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:95 BULLDOG BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3188
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:6100 MINTON RD NW STE 102
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1900
Practice Address - Country:US
Practice Address - Phone:321-724-1171
Practice Address - Fax:321-724-9024
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 48458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD82306Medicare UPIN