Healthcare Provider Details

I. General information

NPI: 1902129463
Provider Name (Legal Business Name): MEYLIN MARTINEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 20 EDIFICIO A 15 APARTAMENTO 4A
TRUJILLO ALTO PR
00977
US

IV. Provider business mailing address

APARTAMENTO INTERAMERICANA GARDENS EDIFICIO A-15 APT 4A
TRUJILLO ALTO PR
00977
US

V. Phone/Fax

Practice location:
  • Phone: 787-810-5592
  • Fax:
Mailing address:
  • Phone: 787-810-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number29288
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number29288
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: