Provider Demographics
NPI:1558322313
Name:MARTINEZ-LLORENS, JORGE EDUARDO (M D)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:EDUARDO
Last Name:MARTINEZ-LLORENS
Suffix:
Gender:M
Credentials:M D
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 29460
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0460
Mailing Address - Country:US
Mailing Address - Phone:787-758-2000
Mailing Address - Fax:787-294-0527
Practice Address - Street 1:735 AVE. PONCE DE LEON
Practice Address - Street 2:DPTO. RADIOLOGIA 3R PISO
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919-5022
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:787-294-0527
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR129322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH70323Medicare UPIN
FL78822Medicare ID - Type UnspecifiedMEDICARE NUMBER