Provider Demographics
NPI:1225702723
Name:BURGOS MARTINEZ, LIDYNELL MARIE
Entity Type:Individual
Prefix:
First Name:LIDYNELL
Middle Name:MARIE
Last Name:BURGOS 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 1:2246 COND VISTA REAL II
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-7854
Mailing Address - Country:US
Mailing Address - Phone:787-214-6940
Mailing Address - Fax:
Practice Address - Street 1:2246 COND VISTA REAL II
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-7854
Practice Address - Country:US
Practice Address - Phone:787-214-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program