Provider Demographics
NPI:1235323668
Name:MARTINEZ-MARTI, MELISA RAQUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MELISA
Middle Name:RAQUEL
Last Name:MARTINEZ-MARTI
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 79594
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9594
Mailing Address - Country:US
Mailing Address - Phone:787-768-8944
Mailing Address - Fax:787-768-8944
Practice Address - Street 1:AVE. FRAGOSO 4ES5
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-768-8944
Practice Address - Fax:787-768-8944
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17,950207R00000X, 207RR0500X
PR17950207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHO234ZMedicare PIN