Healthcare Provider Details

I. General information

NPI: 1225366032
Provider Name (Legal Business Name): LAURA MARTINEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MEDICO RIO PIEDRAS
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 191811
SAN JUAN PR
00919-1811
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-4149
  • Fax:
Mailing address:
  • Phone: 787-763-4149
  • Fax: 787-999-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4931
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: