Healthcare Provider Details

I. General information

NPI: 1972717239
Provider Name (Legal Business Name): JORGE L MARTINEZ TRABAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO TORRE MEDICA SAN LUCAS STE 602
PONCE PR
00716-4728
US

IV. Provider business mailing address

604 CALLE FELIPE MANSION REAL
COTO LAUREL PR
00780-2640
US

V. Phone/Fax

Practice location:
  • Phone: 787-651-1429
  • Fax: 787-651-1430
Mailing address:
  • Phone: 787-651-1429
  • Fax: 787-651-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number14241
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: