Provider Demographics
NPI:1598305617
Name:MARTINEZ, MIGDALIA
Entity Type:Individual
Prefix:
First Name:MIGDALIA
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:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0396
Mailing Address - Country:US
Mailing Address - Phone:787-828-4499
Mailing Address - Fax:787-828-4747
Practice Address - Street 1:CARR 144 KM 3.7
Practice Address - Street 2:BO JAYUYA ABAJO, SECTOR SANTA CLARA
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664
Practice Address - Country:US
Practice Address - Phone:787-828-4499
Practice Address - Fax:787-828-4747
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist