Provider Demographics
NPI:1174193494
Name:MARTINEZ ORTIZ, LUIS ANGEL
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:MARTINEZ ORTIZ
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:HC 4 BOX 6092
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9663
Mailing Address - Country:US
Mailing Address - Phone:787-634-4237
Mailing Address - Fax:
Practice Address - Street 1:43 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3120
Practice Address - Country:US
Practice Address - Phone:787-634-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR35741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program