Provider Demographics
NPI:1609844331
Name:MARTINEZ, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:MARTINEZ
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 351
Mailing Address - Street 2:
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688-0351
Mailing Address - Country:US
Mailing Address - Phone:787-239-5545
Mailing Address - Fax:787-815-4059
Practice Address - Street 1:62 JARIALITOS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-5264
Practice Address - Country:US
Practice Address - Phone:787-815-4059
Practice Address - Fax:787-815-4059
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14969208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100145OtherMEDICARE MUCHO MAS
PR22138OtherTRIPLE C REFORMA
PRA - 027OtherFIRST MEDICAL
PR22138OtherTRIPLE C REFORMA
PRI - 02085Medicare UPIN
PR0022138Medicare ID - Type Unspecified