Provider Demographics
NPI:1366451502
Name:MARTINEZ FORTIER, FELIX (MD)
Entity type:Individual
Prefix:DR
First Name:FELIX
Middle Name:
Last Name:MARTINEZ FORTIER
Suffix:
Gender:M
Credentials:MD
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 250358
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0358
Mailing Address - Country:US
Mailing Address - Phone:787-890-3004
Mailing Address - Fax:787-872-3650
Practice Address - Street 1:79 CALLE MANUEL CORCHADO JUARBE
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2917
Practice Address - Country:US
Practice Address - Phone:787-872-3650
Practice Address - Fax:787-872-3650
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26721Medicare ID - Type Unspecified
PR79581Medicare UPIN