Healthcare Provider Details

I. General information

NPI: 1639797145
Provider Name (Legal Business Name): EDNIRIS MARIE BARRETO MARTINEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. ARTERIAL HOSTOS
SAN JUAN PR
00919
US

IV. Provider business mailing address

PO BOX 140328
ARECIBO PR
00614-0328
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-8282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22756
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: