Healthcare Provider Details

I. General information

NPI: 1457513657
Provider Name (Legal Business Name): DR DAVID E MARTINEZ MELENDEZ SERVICIOS REUMATOLOGICOS CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 AVE WINSTON CHURCHILL # MSC753
SAN JUAN PR
00926-6013
US

IV. Provider business mailing address

138 WINSTON CHURCHILL PMB 753
SAN JUAN PR
00926-6023
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-8944
  • Fax:
Mailing address:
  • Phone: 787-768-8944
  • Fax: 787-790-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number6079
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number6079
License Number StatePR

VIII. Authorized Official

Name: DR. DAVID E MARTINEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-768-8944