Healthcare Provider Details

I. General information

NPI: 1134189400
Provider Name (Legal Business Name): ROSENDO EMILIO MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BY PASS SUITE 401
PONCE PR
00717-1320
US

IV. Provider business mailing address

2225 PONCE BY PASS SUITE 401
PONCE PR
00717-1320
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-9450
  • Fax: 787-840-9454
Mailing address:
  • Phone: 787-840-9450
  • Fax: 787-840-9454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number8781
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: