Provider Demographics
NPI:1417168048
Name:MARTINEZ, BETZAIDA
Entity Type:Individual
Prefix:
First Name:BETZAIDA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:K20 CALLE 13
Mailing Address - Street 2:VAN SCOY
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-5871
Mailing Address - Country:US
Mailing Address - Phone:787-365-4508
Mailing Address - Fax:
Practice Address - Street 1:K20 CALLE 13
Practice Address - Street 2:VAN SCOY
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-5871
Practice Address - Country:US
Practice Address - Phone:787-365-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3257183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician