Provider Demographics
NPI:1144223496
Name:MARTINEZ-DELIZ, IVAN GILBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:GILBERTO
Last Name:MARTINEZ-DELIZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:AVENIDA CORAZONES SUITES 108-107
Mailing Address - Street 2:EDIFICIO MEDICO PROFESIONAL, CENTRO TERAPIA FISICA
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-7063
Mailing Address - Country:US
Mailing Address - Phone:787-834-5640
Mailing Address - Fax:787-832-6141
Practice Address - Street 1:1065 AVENIDA CORAZONES SUITES 107-108
Practice Address - Street 2:EDIFICIO MEDICO PROFESIONAL, CENTRO TERAPIA FISICA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-7063
Practice Address - Country:US
Practice Address - Phone:787-834-5640
Practice Address - Fax:787-832-6141
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2015-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR5735208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27406Medicare ID - Type UnspecifiedPHYSICIAN -PHYSIATRIST
PRD-08415Medicare UPIN