Provider Demographics
NPI:1639474646
Name:MARTINEZ, MELVIN MIGUEL (PSY D)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:MIGUEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. EXT. PARKVILLE
Mailing Address - Street 2:CALLE NEVADA ZA-8
Mailing Address - City:GUAYNABO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00627
Mailing Address - Country:UM
Mailing Address - Phone:787-599-1025
Mailing Address - Fax:
Practice Address - Street 1:1130 CALLE VALLEJO
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3440
Practice Address - Country:US
Practice Address - Phone:787-274-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3779103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical