Provider Demographics
NPI:1235420886
Name:SAWH-MARTINEZ, RAJENDRA FERNANDO (MD, MHS)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:FERNANDO
Last Name:SAWH-MARTINEZ
Suffix:
Gender:M
Credentials:MD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4459
Mailing Address - Country:US
Mailing Address - Phone:773-818-1544
Mailing Address - Fax:407-777-4508
Practice Address - Street 1:2629 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4459
Practice Address - Country:US
Practice Address - Phone:407-632-1010
Practice Address - Fax:407-777-4508
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55765208200000X
FLME136100208200000X
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1235420886Medicaid