Healthcare Provider Details

I. General information

NPI: 1376606038
Provider Name (Legal Business Name): EMANUEL ERNESTO MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 MCPHERSON RD STE 200
LAREDO TX
78041-6505
US

IV. Provider business mailing address

3306 PAVIN DR
LAREDO TX
78045-8469
US

V. Phone/Fax

Practice location:
  • Phone: 956-722-6777
  • Fax: 956-722-7679
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH6409
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: