Provider Demographics
NPI:1396739538
Name:LUZ E MARTINEZ
Entity type:Organization
Organization Name:LUZ E MARTINEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-896-3076
Mailing Address - Street 1:21 CALLE SEVERO ARANA
Mailing Address - Street 2:STE 1
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2310
Mailing Address - Country:US
Mailing Address - Phone:787-896-3076
Mailing Address - Fax:787-896-3076
Practice Address - Street 1:21 CALLE SEVERO ARANA
Practice Address - Street 2:STE 1
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2310
Practice Address - Country:US
Practice Address - Phone:787-896-3076
Practice Address - Fax:787-896-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR674291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38149Medicare PIN