Basic Information
| Provider Information | |||||||||
| NPI: | 1093703159 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ DIAZ | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PARQUE MANTEVERDE II | ||||||||
| Address2: | #02 MARGARITA ST | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009266000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877310355 | ||||||||
| FaxNumber: | 7872871123 | ||||||||
| Practice Location | |||||||||
| Address1: | CALLE JOSE C VAZQUEZ INTEVRON | ||||||||
| Address2: | SUITE 204 EDIFICIO PROFESSIONAL HOSPITAL MENONITA | ||||||||
| City: | ALBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877350023 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 7384 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.