Healthcare Provider Details

I. General information

NPI: 1457341828
Provider Name (Legal Business Name): LUIS E MARTINEZ VEGA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1681 PASEO VILLA FLORES SUITE 201
PONCE PR
00716
US

IV. Provider business mailing address

P.O. BOX 476
MERCEDITA PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-989-4798
  • Fax: 787-651-7365
Mailing address:
  • Phone: 787-989-4798
  • Fax: 787-651-7365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number306
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: