Doctor Name: | DR. ELISAMUEL MARTINEZ DIAZ |
NPI Number: | 1033173745 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 2559 |
Business Practice Address: | 128 Calle Font Martelo Humacao, PR - 007913346 |
Business Phone Number: | 1787594782 |
Business Fax Number: | |
Mailing Address: | # 128 Font Martelo Avenue, HUMACAO |
State: | PR |
Postal Code: | 00791 |
Phone Number: | 1787594782 |
Fax Number: | |
NPI Enumeration Date: | 04/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2559 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |