Healthcare Provider Details

I. General information

NPI: 1962290320
Provider Name (Legal Business Name): MEDICINA PRIMARIA Y PREVENTIVA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A-6 URB.VILLA VERDE CARRETERA 722
AIBONITO PR
00705-4118
US

IV. Provider business mailing address

A6 URB VILLA VERDE
AIBONITO PR
00705-4118
US

V. Phone/Fax

Practice location:
  • Phone: 787-991-0934
  • Fax:
Mailing address:
  • Phone: 787-991-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA M MARTINEZ ORTIZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 787-361-7635