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General NPI Number Information
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NPI Number | 1205793569
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Entity Type | Individual
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Provider Name | MARANGELY DE LOURDES MARTINEZ JUSTINIANO
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Gender | Female
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 500 AVE. RAMON LUIS RIVERA SUITE G DAVINSON PLAZA
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 945-386-5556
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Fax |
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Provider Business Mailing Address
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Address Line | L15 CALLE 9 W
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City | GURABO
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State | PR
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Zip | 00778-4046
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Country | US
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Telephone | 945-386-5556
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2950-P.A
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License Number State | PR
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