Healthcare Provider Details

I. General information

NPI: 1659292399
Provider Name (Legal Business Name): LIVENNY MARTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JUAN CITY HOSPITAL CENTRO MEDICO DE PUERTO RICO MONACILLOS STREET
SAN JUAN PR
00921
US

IV. Provider business mailing address

960 CALLE RUISENOR
SAN JUAN PR
00924-3359
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: