Provider Demographics
NPI:1033105580
Name:MARTINEZ, JOHANNA L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PMB 2179 BOX 4956
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:939-337-5512
Mailing Address - Fax:939-337-5508
Practice Address - Street 1:2 CALLE MUNOZ RIVERA
Practice Address - Street 2:PROFESSIONAL CENTER 207
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2603
Practice Address - Country:US
Practice Address - Phone:787-744-3883
Practice Address - Fax:787-744-3883
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021125Medicare ID - Type Unspecified
PRI18184Medicare UPIN