Provider Demographics
NPI:1073569059
Name:DAGOBERTO MARTINEZ, MDPA
Entity Type:Organization
Organization Name:DAGOBERTO MARTINEZ, MDPA
Other - Org Name:CLINICA SANTA MARIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORE
Authorized Official - Suffix:
Authorized Official - Credentials:WHCNP
Authorized Official - Phone:956-544-2001
Mailing Address - Street 1:95 E PRICE RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3531
Mailing Address - Country:US
Mailing Address - Phone:956-544-2001
Mailing Address - Fax:956-546-4567
Practice Address - Street 1:95 E PRICE RD BLDG A
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3531
Practice Address - Country:US
Practice Address - Phone:956-544-2001
Practice Address - Fax:956-546-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9002000000A99J0OtherBLUE CROSS AND BLUE SHIEL
TX081598701Medicaid
TX9002000000A99J0OtherBLUE CROSS AND BLUE SHIEL