Healthcare Provider Details

I. General information

NPI: 1801483003
Provider Name (Legal Business Name): KARLA DENNISE MARTINEZ CASIANO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/04/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL EMPORIUM II EDIFICIO SANTANDER SUITE 307
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

EXTENSION COQUI C/ PALOMA #37
SALINAS PR
00704
US

V. Phone/Fax

Practice location:
  • Phone: 939-218-4299
  • Fax:
Mailing address:
  • Phone: 787-450-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6382
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: