Healthcare Provider Details

I. General information

NPI: 1013366418
Provider Name (Legal Business Name): RAFAEL MARTINEZ LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PASEO DEL CRISTO
DORADO PR
00646-4999
US

IV. Provider business mailing address

J15 CALLE AZULES DEL MAR DORADO DEL MAR
DORADO PR
00646-2170
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-1837
  • Fax:
Mailing address:
  • Phone: 787-587-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4071
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: