Provider Demographics
NPI:1184859878
Name:MARTE, MADELIN A
Entity Type:Individual
Prefix:
First Name:MADELIN
Middle Name:A
Last Name:MARTE
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:A15 CALLE EUGENIO MARIA DE HOSTO
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3783
Mailing Address - Country:US
Mailing Address - Phone:787-794-0718
Mailing Address - Fax:
Practice Address - Street 1:35 AVE LOS DOMINICOS
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3400
Practice Address - Country:US
Practice Address - Phone:787-795-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-25
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7544183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician