Healthcare Provider Details

I. General information

NPI: 1750218574
Provider Name (Legal Business Name): CHRISTIAN G MADERA MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 AV. PEDRO ALBIZU CAMPOS
GUAYAMA PR
00784
US

IV. Provider business mailing address

10011 AV. PEDRO ALBIZU CAMPOS
GUAYAMA PR
00784
US

V. Phone/Fax

Practice location:
  • Phone: 787-864-4300
  • Fax:
Mailing address:
  • Phone: 787-864-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17592-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: