MEDICARE: DR. MANUEL ANTONIO MARTINEZ-GONZALEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	11766	PR

General Provider Information

NPI Number	:	1790789485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL ANTONIO MARTINEZ-GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	2431 LAS AMERICAS AVE.
Second Line	:	SUITE 308
City	:	PONCE
State	:	PR
Zip	:	00717-2116
Country	:	US
Telephone Number	:	787-844-9442
Fax Number	:	787-844-9444

Provider Business Practice Location Address
First Line	:	2431 LAS AMERICAS AVE.
Second Line	:	SUITE 308
City	:	PONCE
State	:	PR
Zip	:	00717-2116
Country	:	US
Telephone Number	:	787-844-9442
Fax Number	:	787-844-9444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/05/2010

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Directions to “ DR. MANUEL ANTONIO MARTINEZ-GONZALEZ M.D.” Practice Location

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