Provider Demographics
NPI:1396183562
Name:DIABETES AND METABOLISM INSTITUTE OF PUERTO RICO, PSC
Entity Type:Organization
Organization Name:DIABETES AND METABOLISM INSTITUTE OF PUERTO RICO, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-547-6355
Mailing Address - Street 1:10 2 SALAMANCA STEET
Mailing Address - Street 2:TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-547-6355
Mailing Address - Fax:
Practice Address - Street 1:525 F.D. ROOSEVELT AVENUE
Practice Address - Street 2:LA TORRE DE PLAZA SUITE 711
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-547-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16867207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty