Provider Demographics
NPI:1326183047
Name:MARTINEZ - TABOAS, MARIA DE LOURDES (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LOURDES
Last Name:MARTINEZ - TABOAS
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:BAIROA SHOPPING CENTER
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1809
Mailing Address - Country:US
Mailing Address - Phone:787-384-7324
Mailing Address - Fax:787-746-2207
Practice Address - Street 1:BAIROA SHOPPING CENTER
Practice Address - Street 2:SUITE # 7
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1809
Practice Address - Country:US
Practice Address - Phone:787-384-7324
Practice Address - Fax:787-746-2207
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR130472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry