Healthcare Provider Details

I. General information

NPI: 1275840720
Provider Name (Legal Business Name): ANA MARIA PABON MARTINEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2010
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND PLAZA UNIVERSIDAD # 2000 839 CALLE ANASCO APR 818
SAN JUAN PR
00925-2450
US

IV. Provider business mailing address

PO BOX 3308
AGUADILLA PR
00605-3308
US

V. Phone/Fax

Practice location:
  • Phone: 787-231-9553
  • Fax:
Mailing address:
  • Phone: 787-231-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19018
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number19018
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number104147
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: