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General NPI Number Information
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NPI Number | 1730385576
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Entity Type | Individual
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Provider Name | JORGE IVAN MARTINEZ OSORIO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 5005 N PIEDRAS ST NEPHROLOGY CLINIC
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City | EL PASO
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State | TX
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Zip | 79920-5001
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Country | US
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Telephone | 915-742-2603
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Fax |
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Provider Business Mailing Address
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Address Line | 3704 TIERRA LISBOA LN
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City | EL PASO
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State | TX
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Zip | 79938-4383
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Country | US
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Telephone | 210-428-7697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 51843-20
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License Number State | WI
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