Provider Demographics
NPI:1710002753
Name:IGLESIAS, MARTIN (MD,)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:MARTIN
Other - Middle Name:
Other - Last Name:IGLESIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,
Mailing Address - Street 1:1344 CALLE DECATUR
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-3738
Mailing Address - Country:US
Mailing Address - Phone:787-783-8379
Mailing Address - Fax:
Practice Address - Street 1:112 CALLE ARZUAGA
Practice Address - Street 2:OFFICE #606
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3321
Practice Address - Country:US
Practice Address - Phone:787-764-8296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15241146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022433Medicare ID - Type UnspecifiedPROVEEDOR
PRI11260Medicare UPIN