Healthcare Provider Details

I. General information

NPI: 1730729831
Provider Name (Legal Business Name): JOSE JUAN MARTES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 144 KM 3.7 BO JAYUYA ABAJO, SECTOR SANTA CLARA
JAYUYA PR
00664
US

IV. Provider business mailing address

PO BOX 396
JAYUYA PR
00664-0396
US

V. Phone/Fax

Practice location:
  • Phone: 787-828-4499
  • Fax: 787-828-4747
Mailing address:
  • Phone: 787-617-8651
  • Fax: 787-828-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number004069
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: