Provider Demographics
NPI:1245546811
Name:MARTINEZ, IRENES (LIC)
Entity type:Individual
Prefix:MRS
First Name:IRENES
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE MIGUEL MAYMON #917
Mailing Address - Street 2:URB. RIO CRISTAL
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-356-2339
Mailing Address - Fax:
Practice Address - Street 1:CALLE MIGUEL MAYMON #917
Practice Address - Street 2:URB. RIO CRISTAL
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-356-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR857156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician