Provider Demographics
NPI:1033140942
Name:LAUREANO MARTI, PABLO SR (MD)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:
Last Name:LAUREANO MARTI
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:PABLO
Other - Middle Name:
Other - Last Name:LAUREANO MARTI
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-0470
Mailing Address - Country:US
Mailing Address - Phone:787-671-2766
Mailing Address - Fax:787-746-8277
Practice Address - Street 1:715 AVE PONCE DE LEON
Practice Address - Street 2:HOSPITAL AUXILIO MUTUO
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-671-2766
Practice Address - Fax:787-746-8277
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9660207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E66304Medicare UPIN
0081694Medicare ID - Type Unspecified