Provider Demographics
NPI:1124433214
Name:MARTINEZ RIVERA, MARISELA
Entity type:Individual
Prefix:
First Name:MARISELA
Middle Name:
Last Name:MARTINEZ RIVERA
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 1:32 PASEO FELICIDAD
Mailing Address - Street 2:URB LAS QUINTAS
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-3750
Mailing Address - Country:US
Mailing Address - Phone:787-862-0413
Mailing Address - Fax:
Practice Address - Street 1:550 CALLE SERGIO CUEVAS ESQ DOMENECH
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-758-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13453-I282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital