Provider Demographics
NPI:1619221512
Name:MARTINEZ, DANIEL LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LOUIS
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 13 M39
Mailing Address - Street 2:BAYAMON GARDENS
Mailing Address - City:BAYAMON
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00957
Mailing Address - Country:UM
Mailing Address - Phone:787-396-1364
Mailing Address - Fax:
Practice Address - Street 1:M39 CALLE 13
Practice Address - Street 2:BAYAMON GARDENS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-2414
Practice Address - Country:US
Practice Address - Phone:787-396-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR901172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker