=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285973131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. CHARLENE M MARTINEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2013
-----------------------------------------------------
Last Update Date | 02/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CAROLINA SHOPP CTR CALLE A 122 B#3
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00985-5672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-969-9917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | URB. VILLA CAROLINA CALLE A 122 B#3
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-969-9917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 17170
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------