Provider Demographics
NPI:1992715221
Name:MARTINEZ, ELIAS (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DC5 CALLE LOMAS
Mailing Address - Street 2:VALLE VERDE 3
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3343
Mailing Address - Country:US
Mailing Address - Phone:787-261-1871
Mailing Address - Fax:
Practice Address - Street 1:DC5 CALLE LOMAS
Practice Address - Street 2:VALLE VERDE 3
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3343
Practice Address - Country:US
Practice Address - Phone:787-261-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12659208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G61306Medicare UPIN
89272Medicare ID - Type Unspecified