Provider Demographics
NPI:1871662320
Name:MARTINEZ, MIRIAM YAMIL
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:YAMIL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-03 BOX 16391
Mailing Address - Street 2:BO. CUCHILLAS,SECTOR EL GUAYABO
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-219-8366
Mailing Address - Fax:
Practice Address - Street 1:HC-03 BOX 16391
Practice Address - Street 2:BO. CUCHILLAS,SECTOR EL GUAYABO
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-219-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician