Individual provider Active NPI

Jose Luis Martinez Fernandez, MD

  • Internal Medicine Physician
  • San Juan, PR
National Provider Identifier
1477542322
Registry record updated Jun 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
6062 Issued in PR
Practice address
400 Ave Domenech
Ste 413
San Juan, PR 00918-3710
Phone
(787) 753-7383
Fax
(787) 753-7586
NPI assigned
Oct 13, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 6062 PR Primary

Addresses

Primary practice location

400 Ave Domenech
Ste 413
San Juan, PR 00918-3710

Mailing address

400 Ave Domenech
Ste 413
San Juan, PR 00918-3710
Phone (787) 753-7383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101104001488 PR Practitioner - Internal Medicine 9436343258 Practice locations: San Juan, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6062PRMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309305600000",
    "number": "1477542322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 AVE DOMENECH",
            "address_2": "STE 413",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009183710",
            "telephone_number": "787-753-7383",
            "fax_number": "787-753-7586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 AVE DOMENECH",
            "address_2": "STE 413",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009183710",
            "telephone_number": "787-753-7383",
            "fax_number": "787-753-7586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ FERNANDEZ",
        "first_name": "JOSE",
        "middle_name": "LUIS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2011-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PR",
            "license": "6062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.