Provider Demographics
NPI:1366100687
Name:MARTINEZ SIFRE, PEDRO A
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:A
Last Name:MARTINEZ SIFRE
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:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0902
Mailing Address - Country:US
Mailing Address - Phone:787-280-2288
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 111 KM 14.5
Practice Address - Street 2:BARRIO HATO ARRIBA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR040175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR040OtherNATUROPATHY LICENSE NUMBER