Healthcare Provider Details

I. General information

NPI: 1366549388
Provider Name (Legal Business Name): VICTOR M MARTINEZ SUAREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CALLE MUNOZ RIVERA
PENUELAS PR
00624-2015
US

IV. Provider business mailing address

PO BOX 5160
YAUCO PR
00698-5160
US

V. Phone/Fax

Practice location:
  • Phone: 787-836-1683
  • Fax: 787-836-1683
Mailing address:
  • Phone: 787-856-4550
  • Fax: 787-856-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15747
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: