Healthcare Provider Details

I. General information

NPI: 1073594404
Provider Name (Legal Business Name): EDILBERTO MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 10/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 CALLE SANTA CRUZ EDIF. MEDICO SANTA CRUZ SUITE 413
BAYAMON PR
00961-6910
US

IV. Provider business mailing address

73 CALLE SANTA CRUZ EDIF. MEDICO SANTA CRUZ SUITE 413
BAYAMON PR
00961-6910
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-1445
  • Fax: 787-787-2808
Mailing address:
  • Phone: 787-269-1445
  • Fax: 787-787-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number13733
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: