Provider Demographics
NPI:1346776168
Name:MARTIN, YAIZALMER
Entity Type:Individual
Prefix:
First Name:YAIZALMER
Middle Name:
Last Name:MARTIN
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:PUERTA DE EL SOL 54
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:UM
Mailing Address - Phone:787-884-4445
Mailing Address - Fax:787-884-2202
Practice Address - Street 1:PUERTA DE EL SOL 54
Practice Address - Street 2:SUITE 3
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4973
Practice Address - Country:US
Practice Address - Phone:787-884-4445
Practice Address - Fax:787-884-2202
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8555183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician