Healthcare Provider Details

I. General information

NPI: 1629901608
Provider Name (Legal Business Name): MARTINEZFESHOLDID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 CALLE DE DIEGO
SAN JUAN PR
00923-3002
US

IV. Provider business mailing address

900 CALLE HARVARD
SAN JUAN PR
00927-4810
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-5100
  • Fax:
Mailing address:
  • Phone: 787-402-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN A MARTINEZ FESHOLD
Title or Position: PRESIDENT
Credential: MD
Phone: 787-402-5656