Healthcare Provider Details

I. General information

NPI: 1891827127
Provider Name (Legal Business Name): RAFAEL ANTONIO MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 AVE FD ROOSEVELT APT. 1404
SAN JUAN PR
00917-2725
US

IV. Provider business mailing address

121 AVE ROOSVELT APT. 1404
SAN JUAN PR
00917-2725
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-1456
  • Fax:
Mailing address:
  • Phone: 787-763-1456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2354
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: