Provider Demographics
NPI:1407831514
Name:MARTINEZ, EDDANYS (MD)
Entity Type:Individual
Prefix:
First Name:EDDANYS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
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:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0406
Mailing Address - Country:US
Mailing Address - Phone:787-892-4965
Mailing Address - Fax:787-357-8736
Practice Address - Street 1:100 CALLE HERNAN ALVAREZ
Practice Address - Street 2:PLAZA METROPOLITANA SUITE 104
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4173
Practice Address - Country:US
Practice Address - Phone:787-892-4965
Practice Address - Fax:787-357-8736
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82134Medicare UPIN
PR90158Medicare ID - Type Unspecified