Provider Demographics
NPI:1831641992
Name:MARTINEZ, MARITZA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PHD
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 10610
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0610
Mailing Address - Country:US
Mailing Address - Phone:787-223-4183
Mailing Address - Fax:
Practice Address - Street 1:BUEN SAMARITANO, MEDICAL & PROFESSIONAL PLAZA
Practice Address - Street 2:CARR. 460 KM. 1.2 INT. BO. CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:786-814-0100
Practice Address - Fax:321-206-8603
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5746103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist