Provider Demographics
NPI:1174380307
Name:MARTINEZ RIVERA, KEMUEL
Entity type:Individual
Prefix:
First Name:KEMUEL
Middle Name:
Last Name:MARTINEZ RIVERA
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:VILLA ALBA
Mailing Address - Street 2:CALLE 10, I - 8
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-1757
Mailing Address - Country:US
Mailing Address - Phone:939-253-2602
Mailing Address - Fax:
Practice Address - Street 1:28 CALLE MUNOZ RIVERA W
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-2127
Practice Address - Country:US
Practice Address - Phone:787-823-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR038282163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse