Provider Demographics
NPI:1316181068
Name:MARTINEZ, CAROLINE CASTRO (TO)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:CASTRO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:TO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LOIZA VALLEY ADONIS STREET N-490
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00729
Mailing Address - Country:UM
Mailing Address - Phone:787-550-9143
Mailing Address - Fax:
Practice Address - Street 1:LOIZA VALLEY MALL BAUHINIA STREET
Practice Address - Street 2:AA-8 (2)
Practice Address - City:CANOVANAS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00729
Practice Address - Country:UM
Practice Address - Phone:787-550-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-25
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist