Provider Demographics
NPI:1841587169
Name:MARTINEZ, ODALIS (PHAMD)
Entity Type:Individual
Prefix:
First Name:ODALIS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 VIA ESCORIAL
Mailing Address - Street 2:VILLAS REALES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5344
Mailing Address - Country:US
Mailing Address - Phone:787-647-0288
Mailing Address - Fax:
Practice Address - Street 1:319 VIA ESCORIAL
Practice Address - Street 2:VILLAS REALES
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5344
Practice Address - Country:US
Practice Address - Phone:787-647-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist