1154466738 NPI number — DR. JULIE SUZETTE MARTINEZ D.C.

Table of content: DR. JULIE SUZETTE MARTINEZ D.C. (NPI 1154466738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154466738 NPI number — DR. JULIE SUZETTE MARTINEZ D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
JULIE
Provider Middle Name:
SUZETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154466738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COND. PINE GROVE
Provider Second Line Business Mailing Address:
APT 15A
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-223-9160
Provider Business Mailing Address Fax Number:
787-993-4529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1665 AVE VICTOR LABIOSA
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-223-9160
Provider Business Practice Location Address Fax Number:
787-993-4529
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  416 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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