Provider Demographics
NPI:1689328890
Name:MARTINEZ RUIZ, ITZA MARLIN (DC)
Entity Type:Individual
Prefix:
First Name:ITZA
Middle Name:MARLIN
Last Name:MARTINEZ RUIZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 69001 PMB 128
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0001
Mailing Address - Country:US
Mailing Address - Phone:787-356-7116
Mailing Address - Fax:
Practice Address - Street 1:BO BUENA VISTA CARR 130 KM 7.8
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-356-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR828111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor