Provider Demographics
NPI:1245855808
Name:MARTINEZ ELIZALDE, MARIA INES (MS, PSYD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:INES
Last Name:MARTINEZ ELIZALDE
Suffix:
Gender:F
Credentials:MS, PSYD
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 3381
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3381
Mailing Address - Country:US
Mailing Address - Phone:787-648-4236
Mailing Address - Fax:
Practice Address - Street 1:316 CALLE BONET
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-7432
Practice Address - Country:US
Practice Address - Phone:787-648-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical