Provider Demographics
NPI:1689379935
Name:MARTINEZ, GRISELDA IVETTE (TEC)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:IVETTE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:TEC
Other - Prefix:MRS
Other - First Name:GRISELDA
Other - Middle Name:IVETTE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TEC
Mailing Address - Street 1:4406 AVE MILITAR
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-4158
Mailing Address - Country:US
Mailing Address - Phone:787-872-5943
Mailing Address - Fax:787-830-4788
Practice Address - Street 1:112 AVE AGUSTIN RAMOS CALERO
Practice Address - Street 2:3.6 KM
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-872-2860
Practice Address - Fax:787-872-2860
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8867183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician