Provider Demographics
NPI:1467746107
Name:MARTINEZ-MARIOTTE, IRAIDA (RPH)
Entity Type:Individual
Prefix:
First Name:IRAIDA
Middle Name:
Last Name:MARTINEZ-MARIOTTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CARR 1
Mailing Address - Street 2:BAIROA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1583
Mailing Address - Country:US
Mailing Address - Phone:787-744-2905
Mailing Address - Fax:787-744-2936
Practice Address - Street 1:101 CARR 1
Practice Address - Street 2:BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1583
Practice Address - Country:US
Practice Address - Phone:787-744-2905
Practice Address - Fax:787-744-2936
Is Sole Proprietor?:No
Enumeration Date:2011-05-29
Last Update Date:2011-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist