Provider Demographics
NPI:1275741753
Name:CENTRO DE MEDICINA INTEGRAL AWILDA MARTINEZ
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA INTEGRAL AWILDA MARTINEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AWILDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTINEZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-748-3072
Mailing Address - Street 1:PO BOX 1918
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1918
Mailing Address - Country:US
Mailing Address - Phone:787-748-3072
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 181 KM 8.4
Practice Address - Street 2:BO. LA GLORIA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-748-3072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9463174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty