Provider Demographics
NPI:1073724753
Name:MARTINEZ, MARILUZ
Entity Type:Individual
Prefix:MRS
First Name:MARILUZ
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 5384
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-9691
Mailing Address - Country:US
Mailing Address - Phone:787-857-1667
Mailing Address - Fax:
Practice Address - Street 1:CARRERERA 152 KM 2.8
Practice Address - Street 2:BO. QUEBRADILLAS
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-0959
Practice Address - Country:US
Practice Address - Phone:787-857-7954
Practice Address - Fax:787-857-5249
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3911OtherPROFESIONAL LICENSE