Provider Demographics
NPI:1891847281
Name:MARTIN, ERNESTO LUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:LUIS
Last Name:MARTIN
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:#3 LAGUNA AVE.,
Mailing Address - Street 2:BUILDING III, G-A
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-6546
Mailing Address - Country:US
Mailing Address - Phone:787-923-2459
Mailing Address - Fax:608-313-0887
Practice Address - Street 1:1508 MIRSONIA, UNIT #1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1626
Practice Address - Country:US
Practice Address - Phone:787-923-2459
Practice Address - Fax:608-313-0887
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI499510202084P0802X
PR0168922084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry