Healthcare Provider Details

I. General information

NPI: 1528082690
Provider Name (Legal Business Name): JOSE L MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE SAN RAFAEL 253
SANTURCE PR
00971
US

IV. Provider business mailing address

5 SAN RAFAEL ESTS
TRUJILLO ALTO PR
00976-3072
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-3441
  • Fax:
Mailing address:
  • Phone: 787-293-6824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14371
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: