Healthcare Provider Details

I. General information

NPI: 1629120225
Provider Name (Legal Business Name): JOSE R MARTINEZ BARROSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARGINAL 1 EXT SAN SALVADOR
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 1000
MANATI PR
00674-1000
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-6361
  • Fax: 787-884-3021
Mailing address:
  • Phone: 787-854-6361
  • Fax: 787-884-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number6960
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberTC AMB 122
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: