Provider Demographics
NPI:1982810685
Name:MAURY MARTINEZ, MILDRED (MD)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:MAURY 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 3423
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-3423
Mailing Address - Country:US
Mailing Address - Phone:787-239-9588
Mailing Address - Fax:
Practice Address - Street 1:COMPLEJO CORRECCIONAL DE MAYAQUEZ, AREA MEDICA
Practice Address - Street 2:CARRETERA 105, BARRIO LIMON
Practice Address - City:MAYAQUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-9043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14833207Q00000X
IL036-096378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine