Healthcare Provider Details

I. General information

NPI: 1386442960
Provider Name (Legal Business Name): JUAN JOSE PUERTA MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE DEPARTMENT OF ANESTHESIA
BOSTON MA
02215
US

IV. Provider business mailing address

140 GOULD ST STE 150
NEEDHAM MA
02494-2397
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3112
  • Fax: 617-754-8791
Mailing address:
  • Phone: 617-667-3112
  • Fax: 617-754-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5001579
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: