Healthcare Provider Details

I. General information

NPI: 1356330310
Provider Name (Legal Business Name): CARLOS M MARTINEZ RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 CALLE NELSON PEREA STE 204, DOCTOR'S CENTER
MAYAGUEZ PR
00680-4949
US

IV. Provider business mailing address

27 CALLE NELSON PEREA STE 204, DOCTOR'S CENTER
MAYAGUEZ PR
00680-4949
US

V. Phone/Fax

Practice location:
  • Phone: 787-805-0595
  • Fax: 787-805-0620
Mailing address:
  • Phone: 787-805-0595
  • Fax: 787-805-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number12424
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: