MEDICARE: MR. MARTIN ARZOLA

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	TAC-II-15-62-0979	PR
2	101YP2500X	Professional Counselor	10686	PR

General Provider Information

NPI Number	:	1972856540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTIN ARZOLA

Provider Business Mailing Address
First Line	:	EL TUQUE, NUEVA VIDA S14 L
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-6623
Country	:	US
Telephone Number	:	787-306-2926
Fax Number	:

Provider Business Practice Location Address
First Line	:	EL TUQUE, NUEVA VIDA S14 L
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-6623
Country	:	US
Telephone Number	:	787-306-2926
Fax Number	:

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

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	10/19/2012

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Directions to “ MR. MARTIN ARZOLA ” Practice Location

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