Provider Demographics
NPI:1003822651
Name:GOMEZ, MARTHA YANETTY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:YANETTY
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:EBANO I 4
Mailing Address - Street 2:CAPARRA HILLS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3121
Mailing Address - Country:US
Mailing Address - Phone:787-484-2757
Mailing Address - Fax:787-775-0700
Practice Address - Street 1:CARR 21 U 3 19
Practice Address - Street 2:LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-775-0100
Practice Address - Fax:787-775-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14677207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH90422Medicare UPIN
PR21616Medicare ID - Type UnspecifiedPROVIDER NUMBER