Provider Demographics
NPI:1235205048
Name:MARTINEZ, CARMEN LAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:LAURA
Last Name:MARTINEZ
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:LF 121 VIA PARIS LA ANTIGUA ENCANTADA
Mailing Address - Street 2:
Mailing Address - City:TRYILLO ALLO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-283-8146
Mailing Address - Fax:
Practice Address - Street 1:CALLE BAHUINIA Z 977 LOIZA VALLEY
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-886-1085
Practice Address - Fax:787-886-1085
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR56242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F96809Medicare UPIN
84598MAMedicare ID - Type Unspecified