Healthcare Provider Details

I. General information

NPI: 1518602697
Provider Name (Legal Business Name): JOSUE MARTES MD STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S CALIFORNIA AVE STE 1
CHICAGO IL
60608-1694
US

IV. Provider business mailing address

PO BOX 9020032
SAN JUAN PR
00902-0032
US

V. Phone/Fax

Practice location:
  • Phone: 787-235-6805
  • Fax: 773-522-5855
Mailing address:
  • Phone: 787-721-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125086615
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: