Provider Demographics
NPI:1831680065
Name:MARTINEZ, MARIANA SOFIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:SOFIA
Last Name: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 1:1602 CALLE TIBER
Mailing Address - Street 2:URB. EL PARAISO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2950
Mailing Address - Country:US
Mailing Address - Phone:787-410-9237
Mailing Address - Fax:
Practice Address - Street 1:1602 CALLE TIBER
Practice Address - Street 2:URB. EL PARAISO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2950
Practice Address - Country:US
Practice Address - Phone:787-410-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21636208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program