Provider Demographics
NPI:1194306688
Name:SEDA MARTINEZ, NICHOLE MARIE (MD, PA)
Entity type:Individual
Prefix:MISS
First Name:NICHOLE
Middle Name:MARIE
Last Name:SEDA MARTINEZ
Suffix:
Gender:F
Credentials:MD, PA
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 264
Mailing Address - Street 2:
Mailing Address - City:MARICAO
Mailing Address - State:PR
Mailing Address - Zip Code:00606-0264
Mailing Address - Country:US
Mailing Address - Phone:939-644-6025
Mailing Address - Fax:
Practice Address - Street 1:CARR 105 KM 253
Practice Address - Street 2:SECTOR PUEBLO NUEVO
Practice Address - City:MARICAO
Practice Address - State:PR
Practice Address - Zip Code:00606
Practice Address - Country:US
Practice Address - Phone:939-644-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR946-P.A.363A00000X, 363AM0700X
PR22981208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical