Healthcare Provider Details

I. General information

NPI: 1689794729
Provider Name (Legal Business Name): PEDRO R. MARTINEZ M.C.,M.H.C.,C.P.L.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PEDRO R. MARTINEZ M.C.,M.H.C.,C.P.L.

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

F22 CALLE ARAGON VILLA CONTESA
BAYAMON PR
00956-2778
US

IV. Provider business mailing address

F22 CALLE ARAGON VILLA CONTESA
BAYAMON PR
00956-2778
US

V. Phone/Fax

Practice location:
  • Phone: 787-662-6837
  • Fax:
Mailing address:
  • Phone: 787-662-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1451
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: