Provider Demographics
NPI:1841300423
Name:MAYRA MARTINEZ
Entity type:Organization
Organization Name:MAYRA MARTINEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAUTIER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:1787-420-3778
Mailing Address - Street 1:CALLE 5 BLOQUE G-9
Mailing Address - Street 2:ALTURAS DE VILLA FONTANA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-420-3778
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 849
Practice Address - Street 2:BO. SANTO DOMINGO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-420-3778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-2663416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058276Medicare PIN