Healthcare Provider Details

I. General information

NPI: 1043375595
Provider Name (Legal Business Name): MRS. GRETCHEN L MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CALLE COLON
AGUADA PR
00602-3105
US

IV. Provider business mailing address

VILLAS DE LA PRADERA #121
RINCON PR
00677
US

V. Phone/Fax

Practice location:
  • Phone: 787-868-2300
  • Fax: 787-868-2300
Mailing address:
  • Phone: 787-407-4150
  • Fax: 787-868-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3836
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: