Healthcare Provider Details

I. General information

NPI: 1528284858
Provider Name (Legal Business Name): EDGARD REINALDO MARTINEZ SR. M.S. PH. D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDGARD REINALDO MARTINEZ SR. M.S. PH. D

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GENERAL VALERO AVENUE SUITE 313A SECOND LEVEL
FAJARDO PR
00738-1464
US

IV. Provider business mailing address

PO BOX 1464 P.O. BOX 1464
FAJARDO PR
00738-1464
US

V. Phone/Fax

Practice location:
  • Phone: 787-632-5909
  • Fax: 787-860-1463
Mailing address:
  • Phone: 787-632-5909
  • Fax: 787-860-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number689
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: