Healthcare Provider Details

I. General information

NPI: 1255634127
Provider Name (Legal Business Name): MARTIN SCAMARONI SR. D.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CALLE ATOCHA
PONCE PR
00730-3209
US

IV. Provider business mailing address

PO BOX 2000 PMB 10 MERCEDITA
PONCE PR
00717-8000
US

V. Phone/Fax

Practice location:
  • Phone: 787-409-7030
  • Fax:
Mailing address:
  • Phone: 787-409-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAC-III-15-62-0034
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberTC-III-15-62-0041
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: