Provider Demographics
NPI:1912914391
Name:MARTINO, JUAN R (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:R
Last Name:MARTINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 142529
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2529
Mailing Address - Country:US
Mailing Address - Phone:787-817-0573
Mailing Address - Fax:787-816-0219
Practice Address - Street 1:G5 CALLE MARGINAL
Practice Address - Street 2:URB VISTA AZUL
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-2546
Practice Address - Country:US
Practice Address - Phone:787-817-0573
Practice Address - Fax:787-816-0219
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR12748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6120152OtherHUMANA
PR89544OtherSSS
PRPE3625OtherPAN AMERICAN LIFE
PR11603OtherGLOBAL HEALTH PLAN
PR1912914391OtherFIRST MEDICAL
PR1912914391OtherFIRST PLUS
PR1912914391OtherNATIONAL COMMUNITY SERVICE
PRG66647Medicare UPIN