=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174608756
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADA S MARTINEZ-CRUZ MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE PERIFERAL ED. A PABELLON 2 TERRENOS DE CENTRO MEDICO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-274-5553
-----------------------------------------------------
Fax | 787-274-5554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COND MUNDO FELIZ RODRIGUEZ EMMA ST. APT. 1010
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00979-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-391-1145
-----------------------------------------------------
Fax | 787-274-5554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 5527
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------