A Prestige Wellness Center, PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME96872 Issued in FL

Legal business name

A PRESTIGE WELLNESS CENTER, PA

Practice address

3650 NW 82 Ave
Suite #503
Doral, FL 33166

Phone

(305) 433-2005

Fax

(305) 591-8020

NPI assigned

Nov 4, 2008

Last updated

Aug 16, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Luis A Martinez, MDNPI 1972605533

Title

Owner

Phone

(305) 433-2005

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Luis Alberto Martinez, MD

  • Internal Medicine Physician
  • Doral, FL
  • NPI 1972605533
  Medicare reassignment NPD Authorized official
• Pedro Antonio Noya, ARNP

  • Family Nurse Practitioner
  • Miami, FL
  • NPI 1891957999
  Medicare reassignment NPD
• Daniel Ferrer-Nino

  • Physician Assistant
  • Doral, FL
  • NPI 1962180513
  Medicare reassignment
• Crosleivis Rodriguez

  • Family Nurse Practitioner
  • Miami, FL
  • NPI 1982242335
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281916800000",
    "number": "1093969024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 NW 82 AVE",
            "address_2": "SUITE #503",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "33166",
            "telephone_number": "305-433-2005",
            "fax_number": "305-591-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 NW 82 AVE",
            "address_2": "SUITE #503",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "33166",
            "telephone_number": "305-433-2005",
            "fax_number": "305-591-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A PRESTIGE WELLNESS CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-04",
        "last_updated": "2010-08-16",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-433-2005",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME96872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273654301",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Doral, FL
• Providers in Doral, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.