Provider Demographics
NPI:1649211905
Name:MARTINEZ MEDINA, MARISOL (MD)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:MARTINEZ MEDINA
Suffix:
Gender:F
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:HC 8 BOX 297
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-9720
Mailing Address - Country:US
Mailing Address - Phone:787-643-5862
Mailing Address - Fax:787-841-1821
Practice Address - Street 1:MUNOZ RIVERA # 108
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-2025
Practice Address - Fax:787-254-0235
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15025207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine