Provider Demographics
NPI:1356809438
Name:MARTINEZ, JULIO
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:MARTINEZ
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:PO BOX 7891
Mailing Address - Street 2:PMB 333
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970
Mailing Address - Country:US
Mailing Address - Phone:787-648-0457
Mailing Address - Fax:
Practice Address - Street 1:DORAMAR PLAZA SHOPPING CENTER
Practice Address - Street 2:B275 CARR 693 LOCAL 5
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-980-8008
Practice Address - Fax:787-752-2175
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1211156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician