Provider Demographics
NPI:1417148446
Name:MARTINEZ-MARTINEZ, EDUARDO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:ANTONIO
Last Name:MARTINEZ-MARTINEZ
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:PO BOX 8010
Mailing Address - Street 2:MARINA STATION
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-8010
Mailing Address - Country:US
Mailing Address - Phone:787-550-6855
Mailing Address - Fax:
Practice Address - Street 1:CLINICA ESPANOLA
Practice Address - Street 2:BO. BALBOA SECTOR LA QUINTA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681-0000
Practice Address - Country:US
Practice Address - Phone:787-550-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17045208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1417148446OtherTRIPLE-S
PR002-8410Medicare PIN