Healthcare Provider Details

I. General information

NPI: 1720868847
Provider Name (Legal Business Name): RONALD MARTINEZ ORENCIA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 03/20/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 ELLA T GRASSO BLVD
NEW HAVEN CT
06519-5516
US

IV. Provider business mailing address

12 MURLYN RD
HAMDEN CT
06518-2315
US

V. Phone/Fax

Practice location:
  • Phone: 203-349-9400
  • Fax:
Mailing address:
  • Phone: 203-772-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12466
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: