Provider Demographics
NPI:1861460602
Name:SASTRE-MARTINEZ, EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:SASTRE-MARTINEZ
Suffix:
Gender:M
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:D-79 ZAFIRO ST.
Mailing Address - Street 2:GOLDEN GATE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3415
Mailing Address - Country:US
Mailing Address - Phone:787-793-5289
Mailing Address - Fax:787-869-1800
Practice Address - Street 1:D-79 ZAFIRO ST.
Practice Address - Street 2:GOLDEN GATE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3415
Practice Address - Country:US
Practice Address - Phone:787-793-5289
Practice Address - Fax:787-869-1800
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8360208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29650OtherMEDICAID BC/BS IDENTIFIER