Provider Demographics
NPI:1366744427
Name:MARTINEZ, PEDRO JUAN
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:JUAN
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 CALLE PARAGUAY
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-4029
Mailing Address - Country:US
Mailing Address - Phone:787-674-4460
Mailing Address - Fax:
Practice Address - Street 1:CALLE PARAGUAY 318 URB EL PRADO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4029
Practice Address - Country:US
Practice Address - Phone:787-674-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR416156FX1800X
PR#416156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician