Provider Demographics
NPI:1972231108
Name:MARTINEZ, JUAN SALVADOR
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:SALVADOR
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:SAN JUAN HEALTH CENTER 150 AVENIDA JOSE DE DIEGO
Mailing Address - Street 2:SUITE 608
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:939-240-0379
Mailing Address - Fax:
Practice Address - Street 1:SAN JUAN HEALTH CENTER 150 AVENIDA JODE DE DIEGO
Practice Address - Street 2:SUITE 608
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:939-240-0379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7381103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty