Healthcare Provider Details

I. General information

NPI: 1164331724
Provider Name (Legal Business Name): ABDIEL ENRIQUE MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CAMINO DEL VALLE
TOA ALTA PR
00953-4748
US

IV. Provider business mailing address

34 CAMINO DEL VALLE
TOA ALTA PR
00953-4748
US

V. Phone/Fax

Practice location:
  • Phone: 787-661-4831
  • Fax:
Mailing address:
  • Phone: 787-661-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number008778
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: