Provider Demographics
NPI:1598475071
Name:MARTINEZ RIVERA, ANGELICA MARIA
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:MARTINEZ RIVERA
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 1149
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-1149
Mailing Address - Country:US
Mailing Address - Phone:787-374-6013
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL PLAZA MONSERRATE II
Practice Address - Street 2:CARR 345 KM 2.1 LOCAL 7 Y 8 OFIC 1
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-374-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-25
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR105461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty