Healthcare Provider Details

I. General information

NPI: 1821437237
Provider Name (Legal Business Name): MARINA VIVIANA MARTINEZ-GARRI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 9
BAYAMON PR
00959
US

IV. Provider business mailing address

70 CALLE ALAMANDA APT 6184
GUAYNABO PR
00971-7501
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-8282
  • Fax:
Mailing address:
  • Phone: 787-307-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number19296
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: