MEDICARE: JORGE A MARTINEZ-TORO CP 796

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	796	PR
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	6235	PR
3	103TC0700X	Clinical Psychologist	6235	PR

General Provider Information

NPI Number	:	1457729790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE A MARTINEZ-TORO CP 796

Provider Business Mailing Address
First Line	:	110 CALLE 5
Second Line	:	JARDINES DEL CARIBE
City	:	PONCE
State	:	PR
Zip	:	00728-4466
Country	:	US
Telephone Number	:	787-326-0676
Fax Number	:

Provider Business Practice Location Address
First Line	:	2162 BLVD LUIS A FERRE URB VILLA GRILLASCA
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-0722
Country	:	US
Telephone Number	:	787-840-1110
Fax Number	:	787-840-0003

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

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	02/04/2019

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