Provider Demographics
NPI:1255522561
Name:MARTINEZ, DAISY
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
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 1302
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-5302
Mailing Address - Country:US
Mailing Address - Phone:787-849-2179
Mailing Address - Fax:787-849-2205
Practice Address - Street 1:CALLE 4-L-10 COLINAS DEL OESTE
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-0268
Practice Address - Country:US
Practice Address - Phone:787-849-2179
Practice Address - Fax:787-849-2205
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660571184-5OtherMCS