Healthcare Provider Details

I. General information

NPI: 1396739538
Provider Name (Legal Business Name): LUZ E MARTINEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CALLE SEVERO ARANA STE 1
SAN SEBASTIAN PR
00685-2310
US

IV. Provider business mailing address

21 CALLE SEVERO ARANA STE 1
SAN SEBASTIAN PR
00685-2310
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-3076
  • Fax: 787-896-3076
Mailing address:
  • Phone: 787-896-3076
  • Fax: 787-896-3076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number674
License Number StatePR

VIII. Authorized Official

Name: MS. LUZ E MARTINEZ
Title or Position: DIRECTOR
Credential: MT
Phone: 787-896-3076