Healthcare Provider Details

I. General information

NPI: 1861649709
Provider Name (Legal Business Name): ORVIL MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 1 BOX 4042
UTUADO PR
00641-9110
US

IV. Provider business mailing address

HC 1 BOX 4042
UTUADO PR
00641-9110
US

V. Phone/Fax

Practice location:
  • Phone: 787-566-8476
  • Fax:
Mailing address:
  • Phone: 787-566-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17260
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: