Provider Demographics
NPI:1376673335
Name:MARTINEZ-SIERRA, LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:MARTINEZ-SIERRA
Suffix:
Gender:M
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:SANTA MARIA MEDICAL
Mailing Address - Street 2:450 CALLE FERROCARRIL, STE 210
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1105
Mailing Address - Country:US
Mailing Address - Phone:787-840-5042
Mailing Address - Fax:787-841-6849
Practice Address - Street 1:SANTA MARIA MEDICAL
Practice Address - Street 2:450 CALLE FERROCARRIL, STE 210
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1105
Practice Address - Country:US
Practice Address - Phone:787-840-5042
Practice Address - Fax:787-841-6849
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4589207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4589OtherMEDICAL LICENSE
PR0096848Medicare ID - Type UnspecifiedMEDICARE NUMBER
PR4589OtherMEDICAL LICENSE