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NPI Code Detail

MEDICARE: MAYRA E MARTINEZ MEDINA MD

MEDICARE: MAYRA E MARTINEZ MEDINA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician8190PR

General Provider Information

NPI Number : 1093705543
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAYRA E MARTINEZ MEDINA MD
Provider Business Mailing Address
First Line : PO BOX 1425
Second Line :
City : CIALES
State : PR
Zip : 00638-1425
Country : US
Telephone Number : 787-871-0587
Fax Number : 787-871-4883
Provider Business Practice Location Address
First Line : 4 CALLE HOSPITAL
Second Line :
City : CIALES
State : PR
Zip : 00638-3310
Country : US
Telephone Number : 787-871-0587
Fax Number : 787-871-4883
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 07/08/2007

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