Healthcare Provider Details

I. General information

NPI: 1891464962
Provider Name (Legal Business Name): DR. SAMUEL MARTINEZ JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METRO HEALTHCARE MANANGEMENT SYSTEM BOLIVIA STREET #60
SAN JUAN PR
00918
US

IV. Provider business mailing address

COLLEGE PARK APARTMENTS 200 CALLE ALCALA APT 1702 B
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-230-7530
  • Fax:
Mailing address:
  • Phone: 787-207-6524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: