Provider Demographics
NPI:1013166784
Name:MARTELL CRUZ, JOSE JAIME (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JAIME
Last Name:MARTELL CRUZ
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:PO BOX 1934
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-1934
Mailing Address - Country:US
Mailing Address - Phone:787-217-7077
Mailing Address - Fax:
Practice Address - Street 1:20 CALLE BOBBY CAPO
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-2416
Practice Address - Country:US
Practice Address - Phone:787-803-0040
Practice Address - Fax:787-803-0070
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17271208D00000X
FLACN550261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care