Provider Demographics
NPI:1184713158
Name:LOYOLA MARTINEZ, JOHANNA (OD)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:LOYOLA MARTINEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CAMINO DE LA LOMA
Mailing Address - Street 2:SABANERA
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9480
Mailing Address - Country:US
Mailing Address - Phone:787-485-8161
Mailing Address - Fax:
Practice Address - Street 1:16 PASEO GAUTIER BENITEZ
Practice Address - Street 2:OPTICA LOYOLA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-4020
Practice Address - Fax:787-744-4020
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR051662OtherLA CRUZ AZUL
PR58110OtherTRIPLE S
PR7250354OtherHUMANA INS.
PR50487OtherPREFERRED MDICARE CHOICE
PR660618410OtherMCS
PR7250354OtherHUMANA INS.