MEDICARE: AMALIA MARTINEZ-PICO MD FACC

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	2080P0202X	Pediatric Cardiology Physician	1898	PR

General Provider Information

NPI Number	:	1356323927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMALIA MARTINEZ-PICO MD FACC

Provider Business Mailing Address
First Line	:	400 AVE DOMENECH
Second Line	:	STE 303
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-767-2490
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 AVE DOMENECH
Second Line	:	STE 303
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-767-2490
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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