Provider Demographics
NPI:1477732931
Name:MARTINEZ - GONZALEZ, ELISEO (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISEO
Middle Name:
Last Name:MARTINEZ - GONZALEZ
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 366008
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6008
Mailing Address - Country:US
Mailing Address - Phone:787-722-0386
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE CANDINA
Practice Address - Street 2:APT 7-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1404
Practice Address - Country:US
Practice Address - Phone:787-722-0386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5931223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40572OtherTRIPLE-S PROVIDER ID