Healthcare Provider Details

I. General information

NPI: 1912299967
Provider Name (Legal Business Name): HUGO RUBEN MARTINEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MUELLER BLVD # 102
AUSTIN TX
78723-3079
US

IV. Provider business mailing address

4910 MUELLER BLVD # 102
AUSTIN TX
78723-3079
US

V. Phone/Fax

Practice location:
  • Phone: 512-777-2917
  • Fax: 512-374-1354
Mailing address:
  • Phone: 512-777-2917
  • Fax: 512-374-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10040960
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number57868
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number11018024A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberU8092
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: