Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 796 | PR |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6235 | PR |
Y | 103G00000X | Clinical Psychologist | 6235 | PR |
Y | 103TC0700X | Clinical Psychologist | 6235 | PR |
NPI | 1457729790 |
---|---|
Provider Name | Jorge A Martinez-Toro |
First Address | Ponce, PR 00728-4466 |
Second Address | Ponce, PR 00717-0722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2015 |
Last Update Date | 04/02/2019 |