Provider Demographics
NPI:1952444945
Name:MARTINEZ SERRANO, ELSA R
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:R
Last Name:MARTINEZ SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:R
Other - Last Name:MARTINEZ SERRANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0791
Mailing Address - Country:US
Mailing Address - Phone:787-262-4901
Mailing Address - Fax:787-898-4949
Practice Address - Street 1:CARR. # 2 KM. 85.5
Practice Address - Street 2:HC-01 BOX 791
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-262-4901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4248OtherPHARMACIST