Healthcare Provider Details

I. General information

NPI: 1972597557
Provider Name (Legal Business Name): MARITZA MARTINEZ VARGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA UNIVERSIDAD INTERAMERICANA CALLE 143
SAN GERMAN PUERTO RICO
00683
UM

IV. Provider business mailing address

PO BOX 326
SAN GERMAN PUERTO RICO
00683
UM

V. Phone/Fax

Practice location:
  • Phone: 787-892-6060
  • Fax: 787-892-6060
Mailing address:
  • Phone: 787-892-6060
  • Fax: 787-892-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7568
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: