Active NPI
Paola Katsi Vissepo Martinez, MD
- General Practice Physician
- San Juan, PR
National Provider Identifier
1447877949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 23111
- Practice address
- Carretera 22 Barrio Monacillos
San Juan, PR 00935-0001 - Phone
- (787) 765-5183
- NPI assigned
- Jun 30, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 15482-I | PR | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 23111 | PR | |
| General Practice Physician | 208D00000X | 23111 | PR | Primary |
Addresses
Primary practice location
Carretera 22 Barrio Monacillos
San Juan, PR 00935-0001
Mailing address
PO Box 1464
Trujillo Alto, PR 00977-1464
Phone (787) 632-3308
Other practice location 1
Carr 22 Barrio Monacillos Hospital Oncologico
San Juan, PR 00935-0001
Phone (787) 763-4149
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15482-I | PR | MD | General Practice Physician |
| 23111 | PR | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714435200000",
"number": "1447877949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1464",
"city": "TRUJILLO ALTO",
"state": "PR",
"postal_code": "009771464",
"telephone_number": "787-632-3308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CARRETERA 22 BARRIO MONACILLOS",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009350001",
"telephone_number": "787-765-5183"
}
],
"practiceLocations": [
{
"address_1": "Carr 22 Barrio Monacillos Hospital Oncologico",
"address_purpose": "LOCATION",
"city": "San Juan",
"state": "PR",
"postal_code": "009350001",
"country_code": "US",
"telephone_number": "787-763-4149",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VISSEPO MARTINEZ",
"first_name": "PAOLA",
"middle_name": "KATSI",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-30",
"last_updated": "2024-04-30",
"certification_date": "2024-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "PR",
"license": "15482-I",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "PR",
"license": "23111",
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "PR",
"license": "23111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.