Healthcare Provider Details

I. General information

NPI: 1407971138
Provider Name (Legal Business Name): GILBERT MARTINEZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 MEDICAL DR SUITE 6250
SAN ANTONIO TX
78229-5640
US

IV. Provider business mailing address

16014 VIA SHAVANO
SAN ANTONIO TX
78249-2364
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-3011
  • Fax: 210-615-6906
Mailing address:
  • Phone: 210-614-3011
  • Fax: 210-615-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number30743
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: