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General NPI Number Information
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NPI Number | 1154891950
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Entity Type | Individual
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Provider Name | MARIE ANGELIE MARTINEZ OPT
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Gender | Female
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 56 CALLE COMERCIO
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City | JUANA DIAZ
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State | PR
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Zip | 00795-1633
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Country | US
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Telephone | 787-837-9608
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Fax |
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Provider Business Mailing Address
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Address Line | 5670 PASEO MORELL CAMPOS URB LA MATILDE
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City | PONCE
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State | PR
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Zip | 00728
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Country | US
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Telephone | 939-217-0128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1261
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License Number State | PR
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