Provider Demographics
NPI:1326838566
Name:MARTINEZ, NATHANIEL
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:
Other - Prefix:MR
Other - First Name:NATHANIEL
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:AH11 CALLE 39
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4739
Mailing Address - Country:US
Mailing Address - Phone:787-233-5870
Mailing Address - Fax:
Practice Address - Street 1:700 CARR 2 # 103
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-6073
Practice Address - Country:US
Practice Address - Phone:787-224-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7823103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling