=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619143542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELIZA MARTINEZ RODRIGUEZ MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2008
-----------------------------------------------------
Last Update Date | 05/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 AVE FD ROOSEVELT LA TORRE DE PLAZA STE 711
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00918-8001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-764-8880
-----------------------------------------------------
Fax | 787-777-0011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10-2 CALLE SALAMANCA URB TORRIMAR
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00966-3128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-547-6355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 16867
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------