Active NPI
Mauricio Martin
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Miami, FL
National Provider Identifier
1578011920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- License
- 11-1158-GH
- Practice address
- 20342 SW 129TH PL
Miami, FL 33177-5506 - Phone
- (786) 457-0743
- NPI assigned
- Sep 14, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | 11-1158-GH | FL | Primary |
Addresses
Primary practice location
20342 SW 129TH PL
Miami, FL 33177-5506
Mailing address
20342 SW 129TH PL
Miami, FL 33177-5506
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 016584900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-1158-GH | FL | MD | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473811200000",
"number": "1578011920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20342 SW 129TH PL",
"city": "MIAMI",
"state": "FL",
"postal_code": "331775506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20342 SW 129TH PL",
"city": "MIAMI",
"state": "FL",
"postal_code": "331775506",
"telephone_number": "786-457-0743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "MAURICIO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-14",
"last_updated": "2016-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "320600000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "FL",
"license": "11-1158-GH",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "016584900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.