Provider Demographics
NPI:1184643751
Name:MARTINEZ, JENIFFER COLLAZO
Entity Type:Individual
Prefix:
First Name:JENIFFER
Middle Name:COLLAZO
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:ST. 9
Mailing Address - Street 2:N-18 SANTA TERESITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-780-6889
Mailing Address - Fax:787-272-0746
Practice Address - Street 1:AVE. APOLO
Practice Address - Street 2:COMERCIAL APOLO #9
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-272-0745
Practice Address - Fax:787-272-0746
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004088183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician