1689379935 NPI number — GRISELDA IVETTE MARTINEZ TEC

Table of content: GRISELDA IVETTE MARTINEZ TEC (NPI 1689379935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689379935 NPI number — GRISELDA IVETTE MARTINEZ TEC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
GRISELDA
Provider Middle Name:
IVETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
TEC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTINEZ
Provider Other First Name:
GRISELDA
Provider Other Middle Name:
IVETTE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
TEC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689379935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4406 AVE MILITAR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-4158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-872-5943
Provider Business Mailing Address Fax Number:
787-830-4788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 AVE AGUSTIN RAMOS CALERO
Provider Second Line Business Practice Location Address:
3.6 KM
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-872-2860
Provider Business Practice Location Address Fax Number:
787-872-2860
Provider Enumeration Date:
04/04/2023

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: 183700000X , with the licence number:  8867 , 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)