Healthcare Provider Details

I. General information

NPI: 1952968034
Provider Name (Legal Business Name): DORIS MARTINEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CALLE MUNOZ RIVERA
JUNCOS PR
00777-3112
US

IV. Provider business mailing address

1 GUSTAVE LEVY PLACE 8 CENTER
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 877-228-6821
  • Fax:
Mailing address:
  • Phone: 212-241-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: