Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 1804 | WI |
NPI | 1003979311 |
---|---|
Provider Name | Dr. Carlos Lionel Martinez |
First Address | San Juan, PR 00918 |
Second Address | San Juan, PR 00918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 10/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41677 | TRIPLE S (01) | PR |
829595 | UNITED CONCORDIA (01) | PR |
9200048 | HUMANA (01) | PR |