Provider Demographics
NPI:1467562538
Name:VENDRELL MARTIN, PEDRO J SR (MD- ENT HNS)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:J
Last Name:VENDRELL MARTIN
Suffix:SR
Gender:M
Credentials:MD- ENT HNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LA RAMBLA 1804 COVADONGA ST.
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4077
Mailing Address - Country:US
Mailing Address - Phone:787-842-7132
Mailing Address - Fax:787-842-7132
Practice Address - Street 1:2610 MAYOR ST. CORNER MARINA ST
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2074
Practice Address - Country:US
Practice Address - Phone:787-842-7132
Practice Address - Fax:787-842-7132
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2821207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
92960Medicare ID - Type Unspecified
E10163Medicare UPIN