Provider Demographics
NPI:1962207696
Name:MARTINEZ MOJICA, IVETTE (MS)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:MARTINEZ MOJICA
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 AVE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-4782
Mailing Address - Country:US
Mailing Address - Phone:787-788-4544
Mailing Address - Fax:
Practice Address - Street 1:166 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4782
Practice Address - Country:US
Practice Address - Phone:787-788-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional