MEDICARE: JOSE LUIS MARTINEZ FERNANDEZ MD

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	207R00000X	Internal Medicine Physician	6062	PR

General Provider Information

NPI Number	:	1477542322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE LUIS MARTINEZ FERNANDEZ MD

Provider Business Mailing Address
First Line	:	400 AVE DOMENECH
Second Line	:	STE 413
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-753-7383
Fax Number	:	787-753-7586

Provider Business Practice Location Address
First Line	:	400 AVE DOMENECH
Second Line	:	STE 413
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-753-7383
Fax Number	:	787-753-7586

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	06/29/2011

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