Healthcare Provider Details

I. General information

NPI: 1972231108
Provider Name (Legal Business Name): JUAN SALVADOR MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JUAN HEALTH CENTER 150 AVENIDA JODE DE DIEGO SUITE 608
SAN JUAN PR
00907
US

IV. Provider business mailing address

SAN JUAN HEALTH CENTER 150 AVENIDA JOSE DE DIEGO SUITE 608
SAN JUAN PR
00907
US

V. Phone/Fax

Practice location:
  • Phone: 939-240-0379
  • Fax:
Mailing address:
  • Phone: 939-240-0379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number7381
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: