1215157516 NPI number — MISS JUANITA MARTINEZ MARTINEZ MSW

Table of content: MISS JUANITA MARTINEZ MARTINEZ MSW (NPI 1215157516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215157516 NPI number — MISS JUANITA MARTINEZ MARTINEZ MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
JUANITA
Provider Middle Name:
MARTINEZ
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
JUANITA
Provider Other Middle Name:
MARTINEZ
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215157516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVE. SAN IGNASIO , APT.# 12N, S.J. P.R
Provider Second Line Business Mailing Address:
COND.SAN IGNASIO, APT. 12N, S.J. P.R
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00921-3836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-758-3709
Provider Business Mailing Address Fax Number:
787-758-3709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE MAGA . BO. MONACILLOS , SJ, #B
Provider Second Line Business Practice Location Address:
CALLE MAGA . BO. MONACILLOS ,AMBULATORIO SJ, #B
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-758-3709
Provider Business Practice Location Address Fax Number:
787-758-3709
Provider Enumeration Date:
04/27/2007

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: 1041C0700X , with the licence number:  1993 , 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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