Provider Demographics
NPI:1922338078
Name:KUILAN MARTINEZ, NERYMAR (PSYD)
Entity Type:Individual
Prefix:
First Name:NERYMAR
Middle Name:
Last Name:KUILAN MARTINEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NERYMAR
Other - Middle Name:KUILAN
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY,D
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00648
Mailing Address - Country:US
Mailing Address - Phone:939-204-6566
Mailing Address - Fax:939-204-6567
Practice Address - Street 1:METRO MEDICAL CENTER SUITE A102
Practice Address - Street 2:TORRE A995 PR2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:939-204-6566
Practice Address - Fax:939-204-6567
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TA0700X, 103TB0200X, 103TC2200X, 103TP2701X
PR4008103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$Medicare PIN