MEDICARE: GLENDA MARTINEZ 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
1	208000000X	Pediatrics Physician	10759	PR

General Provider Information

NPI Number	:	1295724896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA MARTINEZ MD

Provider Business Mailing Address
First Line	:	PARKVILLE CLEVELAND F-20
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-4537
Country	:	US
Telephone Number	:	787-887-3011
Fax Number	:	787-809-7089

Provider Business Practice Location Address
First Line	:	VILLAS DE RIO GRANDE AVE PEREZ ANDINO B-29
Second Line	:
City	:	RIO GRANDE
State	:	PR
Zip	:	00745
Country	:	US
Telephone Number	:	787-888-2302
Fax Number	:	787-888-2302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	11/20/2008

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