Healthcare Provider Details

I. General information

NPI: 1477477362
Provider Name (Legal Business Name): GINES A MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA ROBERTO CLEMENTE 124 #8,
CAROLINA PR
00985
US

IV. Provider business mailing address

URB. GRAN VISTA 2 PLAZA 9, CASA #106
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-4920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000998
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: