Provider Demographics
NPI:1043033640
Name:MARTINEZ, MARIELY MARTINEZ SR
Entity type:Individual
Prefix:
First Name:MARIELY
Middle Name:MARTINEZ
Last Name:MARTINEZ
Suffix:SR
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:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0542
Mailing Address - Country:US
Mailing Address - Phone:787-852-2828
Mailing Address - Fax:
Practice Address - Street 1:URB BUZO #443
Practice Address - Street 2:SUITE # 4
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-2828
Practice Address - Fax:787-852-4622
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14064183700000X
PR16046183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician