Provider Demographics
NPI:1376502419
Name:LOYOLA, MARTINEZ, JOSE J
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:LOYOLA, 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:MUNOZ RIVERA ESQ GARRIDO MORALES #1
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1723
Mailing Address - Country:US
Mailing Address - Phone:787-860-1767
Mailing Address - Fax:787-860-1767
Practice Address - Street 1:MUNOZ RIVERA ESQ GARRIDO MORALES #1
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-1723
Practice Address - Country:US
Practice Address - Phone:787-860-1767
Practice Address - Fax:787-860-1767
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist