1275080806 NPI number — MARIELA RAQUEL MARTINEZ-RIVERA MD, MS

Table of content: MARIELA RAQUEL MARTINEZ-RIVERA MD, MS (NPI 1275080806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275080806 NPI number — MARIELA RAQUEL MARTINEZ-RIVERA MD, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ-RIVERA
Provider First Name:
MARIELA
Provider Middle Name:
RAQUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275080806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3806 UNIVERSITY DR APT 406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27707-6892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-794-5710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 ERWIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27710-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-794-5710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 2024-01063 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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