Healthcare Provider Details

I. General information

NPI: 1689334245
Provider Name (Legal Business Name): NAOMI MICHELLE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 167 KILOMETRO 22, PLAZA TROPICAL MALL
BAYAMON PR
00956
US

IV. Provider business mailing address

CARRETERA 167 KILOMETRO 22 PLAZA TROPICAL MALL
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-0773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15336
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: