1356317911 NPI number — DR. JUAN CARLOS MARTINEZ-RODRIGUEZ M.D

Table of content: DR. JUAN CARLOS MARTINEZ-RODRIGUEZ M.D (NPI 1356317911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356317911 NPI number — DR. JUAN CARLOS MARTINEZ-RODRIGUEZ M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ-RODRIGUEZ
Provider First Name:
JUAN
Provider Middle Name:
CARLOS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

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:
1356317911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BAYAMON MEDICAL MALL # 1845
Provider Second Line Business Mailing Address:
CARR #2 SUITE 209
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00959-7200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-620-2098
Provider Business Mailing Address Fax Number:
787-779-8178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BAYAMON MEDICAL MALL # 1845
Provider Second Line Business Practice Location Address:
CARR #2 ST 209
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-620-2098
Provider Business Practice Location Address Fax Number:
787-779-8178
Provider Enumeration Date:
02/24/2006

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: 208600000X , with the licence number:  8967 , 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)

  • Identifier: 31-08967 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6230057 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 067100 . This is a "LA CRUZ AZUL PUERTO RICO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 204183 . This is a "U T I" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 28967 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 601156 . This is a "MEDICARE MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6230057 . This is a "HUMANA HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: N-189 . This is a "IMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 80449 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".