1356330310 NPI number — DR. CARLOS M MARTINEZ RIVERA MD

Table of content: DR. CARLOS M MARTINEZ RIVERA MD (NPI 1356330310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356330310 NPI number — DR. CARLOS M MARTINEZ RIVERA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ RIVERA
Provider First Name:
CARLOS
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1356330310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 CALLE NELSON PEREA
Provider Second Line Business Mailing Address:
STE 204, DOCTOR'S CENTER
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680-4949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-805-0595
Provider Business Mailing Address Fax Number:
787-805-0620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 CALLE NELSON PEREA
Provider Second Line Business Practice Location Address:
STE 204, DOCTOR'S CENTER
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680-4949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-805-0595
Provider Business Practice Location Address Fax Number:
787-805-0620
Provider Enumeration Date:
10/20/2005

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: 207RE0101X , with the licence number:  12424 , 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)





Copyright © 2007-2025 www.npivalidator.com