1811094139 NPI number — DR. LISBETH REYES MARTINEZ

Table of content: DR. LISBETH REYES MARTINEZ (NPI 1811094139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811094139 NPI number — DR. LISBETH REYES MARTINEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES MARTINEZ
Provider First Name:
LISBETH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1811094139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MF7 PLAZA 23
Provider Second Line Business Mailing Address:
MONTECLARO
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00961-4738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-862-4124
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 174 BLOQUE 21 #25
Provider Second Line Business Practice Location Address:
SANTA ROSA
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-862-4124
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

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: 208D00000X , with the licence number:  11471 , 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: 0010857 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 060201 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 88671 . This is a "TRIPLE SSS, INC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8977 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 201953 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PG3256 . This is a "PALIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0300 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8195 . This is a "FEDERACION DE MAESTROS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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