Provider Demographics
NPI:1346883899
Name:MARTINEZ, PEDRO CONCEPCION
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:CONCEPCION
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 AVE ALEJANDRINO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-7038
Mailing Address - Country:US
Mailing Address - Phone:939-244-7333
Mailing Address - Fax:
Practice Address - Street 1:VILLA UNIVERSITARIA BA CALLE 26A #LOC A
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-716-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center