Provider Demographics
NPI:1972856540
Name:ARZOLA, MARTIN
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:ARZOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EL TUQUE, NUEVA VIDA S14 L
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-6623
Mailing Address - Country:US
Mailing Address - Phone:787-306-2926
Mailing Address - Fax:
Practice Address - Street 1:EL TUQUE, NUEVA VIDA S14 L
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-6623
Practice Address - Country:US
Practice Address - Phone:787-306-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTAC-II-15-62-0979101YA0400X
PR10686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)