MEDICARE: MRS. DINYS Y MARTINEZ-QUEZADA

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	183700000X	Pharmacy Technician	14887	PR

General Provider Information

NPI Number	:	1831382209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DINYS Y MARTINEZ-QUEZADA

Provider Business Mailing Address
First Line	:	375 CALLE VIZCARRONDO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00915-2232
Country	:	US
Telephone Number	:	787-550-1691
Fax Number	:	787-781-1734

Provider Business Practice Location Address
First Line	:	375 CALLE VIZCARRONDO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00915-2232
Country	:	US
Telephone Number	:	787-550-1691
Fax Number	:	787-781-1734

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

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	08/20/2007

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