MEDICARE: MR. IVAN GILBERTO MARTINEZ-DELIZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	5735	PR

General Provider Information

NPI Number	:	1144223496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IVAN GILBERTO MARTINEZ-DELIZ M.D.

Provider Business Mailing Address
First Line	:	AVENIDA CORAZONES SUITES 108-107
Second Line	:	EDIFICIO MEDICO PROFESIONAL, CENTRO TERAPIA FISICA
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-7063
Country	:	US
Telephone Number	:	787-834-5640
Fax Number	:	787-832-6141

Provider Business Practice Location Address
First Line	:	1065 AVENIDA CORAZONES SUITES 107-108
Second Line	:	EDIFICIO MEDICO PROFESIONAL, CENTRO TERAPIA FISICA
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-7063
Country	:	US
Telephone Number	:	787-834-5640
Fax Number	:	787-832-6141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	03/12/2015

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