Provider Demographics
NPI:1093700080
Name:PLAZA, MARTA C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:C
Last Name:PLAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3605
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3605
Mailing Address - Country:US
Mailing Address - Phone:787-834-1021
Mailing Address - Fax:787-834-1051
Practice Address - Street 1:CARR 349 KM 2.7 CERRO LAS MESAS
Practice Address - Street 2:HOSPITAL BELLA VISTA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-0000
Practice Address - Country:US
Practice Address - Phone:787-834-1021
Practice Address - Fax:787-834-1051
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13478174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20253OtherTRIPLE S
PR5618OtherFIRST MEDICAL
PRPE4613OtherPAN AMERICAN
PR20170BOtherPREFERRED MEDICARE CHOICE
PR660606085OtherMEDICAL CARD SYSTEM
PR5106085OtherUIA
PR221055OtherPREFERRED UTI
PR660606085OtherPLAN DE SALUD BELLA VISTA
PR6800165OtherHUMANA INSURANCE
PR100041OtherCRUZ AZUL
PR20170BOtherPREFERRED MEDICARE CHOICE
PRPE4613OtherPAN AMERICAN