Healthcare Provider Details

I. General information

NPI: 1962324269
Provider Name (Legal Business Name): LUIS ROBERTO MARTINEZ RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 AVE TTE CESAR LUIS GONZALEZ APT 2002
SAN JUAN PR
00918
US

IV. Provider business mailing address

151 AVE TTE CESAR LUIS GONZALEZ APT 2002
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-237-5147
  • Fax:
Mailing address:
  • Phone: 787-237-5147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7713
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: