Provider Demographics
NPI:1730125410
Name:RODRIGUEZ-MARTINEZ, MARIBEL (MD)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:RODRIGUEZ-MARTINEZ
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:PO BOX 366210
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6210
Mailing Address - Country:US
Mailing Address - Phone:787-758-2000
Mailing Address - Fax:787-771-7869
Practice Address - Street 1:715 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1607
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:787-771-7869
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13316174400000X, 207PP0204X, 208M00000X, 207P00000X
VA0101-049298174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF48280Medicare ID - Type Unspecified
PRF48280Medicare UPIN