Healthcare Provider Details

I. General information

NPI: 1205872512
Provider Name (Legal Business Name): KAREN G. MARTINEZ-GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN G. MARTINEZ-GONZALEZ MD

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLINICA DE LA ESCUELA DE MEDICINA REPARTO METROPOLITANO SHOPPING, AVE. AMERICO MIRANDA
SAN JUAN PR
00921
US

IV. Provider business mailing address

PSIQUIATRIA RCM PO BOX 29134
SAN JUAN PR
00929-0134
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-0940
  • Fax:
Mailing address:
  • Phone: 787-766-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14823
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number14823
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: