Provider Demographics
NPI:1831382209
Name:MARTINEZ-QUEZADA, DINYS Y
Entity type:Individual
Prefix:MRS
First Name:DINYS
Middle Name:Y
Last Name:MARTINEZ-QUEZADA
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 1:375 CALLE VIZCARRONDO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-2232
Mailing Address - Country:US
Mailing Address - Phone:787-550-1691
Mailing Address - Fax:787-781-1734
Practice Address - Street 1:375 CALLE VIZCARRONDO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-2232
Practice Address - Country:US
Practice Address - Phone:787-550-1691
Practice Address - Fax:787-781-1734
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14887183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician