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Organization
MEDICAL FAMILY PRACTICE CTR CSP
Active
Organization
MEDICAL FAMILY PRACTICE CTR CSP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN R MARTINO M.D. (PRESIDENT)
(787) 817-0573
Entity
Organization
Contact information
Practice address
G5 CALLE MARGINAL, URB VISTA AZUL, ARECIBO, PR 00612-2546
(787) 817-0573
(787) 816-0219
Mailing address
PO BOX 142529, ARECIBO, PR 00614-2529
(787) 817-0573
(787) 816-0219
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12748
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16098
AHM
PR
01
—
1700891439
CHAMPVA
PR
01
—
84396
SSS
PR
01
—
DU442A
MEDICARE PTAN
PR
Enumeration date
07/30/2006
Last updated
09/26/2012
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