Provider Demographics
NPI:1447471693
Name:MARTINEZ, AIDA JUDITH
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:JUDITH
Last Name:MARTINEZ
Suffix:
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 1:145 SANTA TERESA
Mailing Address - Street 2:URB SANTA MARINA
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-2914
Mailing Address - Country:US
Mailing Address - Phone:787-830-0743
Mailing Address - Fax:
Practice Address - Street 1:3044 AVE JUAN HERNANDEZ ORTIZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0547
Practice Address - Country:US
Practice Address - Phone:787-872-5110
Practice Address - Fax:787-872-5110
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1972183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician