Healthcare Provider Details

I. General information

NPI: 1023063104
Provider Name (Legal Business Name): GABRIEL MARTINEZ-RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN CRISTOBAL ANEXO TORRE I
PONCE PR
00780
US

IV. Provider business mailing address

PO BOX 34239
PONCE PR
00734-0239
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-2100
  • Fax: 787-813-1836
Mailing address:
  • Phone: 787-813-1836
  • Fax: 787-813-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number11939
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: