Provider Demographics
NPI:1982717294
Name:SANTIAGO MARTINEZ, MYRTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRTA
Middle Name:
Last Name:SANTIAGO MARTINEZ
Suffix:
Gender:F
Credentials:MD
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 397
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0397
Mailing Address - Country:US
Mailing Address - Phone:787-596-7997
Mailing Address - Fax:
Practice Address - Street 1:CALLE RAFAEL CORDERO FINAL
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-0397
Practice Address - Country:US
Practice Address - Phone:787-596-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR067993OtherCRUZ AZUL
PR3682OtherPMC
PR9900188OtherHUMANA
PR28660OtherTRIPLE S
PR9900188OtherHUMANA