Provider Demographics
NPI:1164023560
Name:MARTINEZ, MAURICIO JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:MAURICIO
Middle Name:
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:MAURICIO
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2907 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8137
Mailing Address - Country:US
Mailing Address - Phone:956-220-4792
Mailing Address - Fax:
Practice Address - Street 1:4401 US 83
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046
Practice Address - Country:US
Practice Address - Phone:956-727-1731
Practice Address - Fax:956-727-1770
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist