Individual provider Active NPI

Marangely De Lourdes Martinez Justiniano

  • General Practice Physician
  • Toa Baja, PR
National Provider Identifier
1205793569
Registry record updated Jul 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
17891-I Issued in PR
Practice address
500 Ave. Ramon Luis Rivera Suite G
Davinson Plaza
Toa Baja, PR 00949
Phone
(945) 386-5556
NPI assigned
Jan 8, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 3, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X 17891-I PR Primary

Addresses

Primary practice location

500 Ave. Ramon Luis Rivera Suite G
Davinson Plaza
Toa Baja, PR 00949

Mailing address

L15 Calle 9 W
Gurabo, PR 00778-4046
Phone (945) 386-5556

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2950-P.APRMDPhysician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1767830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783036800000",
    "number": "1205793569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "L15 CALLE 9 W",
            "city": "GURABO",
            "state": "PR",
            "postal_code": "007784046",
            "telephone_number": "945-386-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 AVE. RAMON LUIS RIVERA SUITE G",
            "address_2": "DAVINSON PLAZA",
            "city": "TOA BAJA",
            "state": "PR",
            "postal_code": "00949",
            "telephone_number": "945-386-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ JUSTINIANO",
        "first_name": "MARANGELY",
        "middle_name": "DE LOURDES",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-01-08",
        "last_updated": "2026-07-03",
        "certification_date": "2026-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "PR",
            "license": "17891-I",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toa Baja, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.