Healthcare Provider Details

I. General information

NPI: 1124433214
Provider Name (Legal Business Name): MARISELA MARTINEZ RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CALLE SERGIO CUEVAS ESQ DOMENECH HATO REY
SAN JUAN PR
00926
US

IV. Provider business mailing address

32 PASEO FELICIDAD URB LAS QUINTAS
MOROVIS PR
00687-3750
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-8383
  • Fax:
Mailing address:
  • Phone: 787-862-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13453-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: