1144223496 NPI number — MR. IVAN GILBERTO MARTINEZ-DELIZ M.D.

Table of content: MR. IVAN GILBERTO MARTINEZ-DELIZ M.D. (NPI 1144223496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144223496 NPI number — MR. IVAN GILBERTO MARTINEZ-DELIZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ-DELIZ
Provider First Name:
IVAN
Provider Middle Name:
GILBERTO
Provider Name Prefix Text:
MR.
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:
1144223496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVENIDA CORAZONES SUITES 108-107
Provider Second Line Business Mailing Address:
EDIFICIO MEDICO PROFESIONAL, CENTRO TERAPIA FISICA
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680-7063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-5640
Provider Business Mailing Address Fax Number:
787-832-6141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 AVENIDA CORAZONES SUITES 107-108
Provider Second Line Business Practice Location Address:
EDIFICIO MEDICO PROFESIONAL, CENTRO TERAPIA FISICA
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-7063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-5640
Provider Business Practice Location Address Fax Number:
787-832-6141
Provider Enumeration Date:
05/31/2005

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: 208100000X , with the licence number:  5735 , 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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