Provider Demographics
NPI:1326077686
Name:MARTINEZ, ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AVE DOMENECH
Mailing Address - Street 2:LAS AMERICAS PROFESSIONAL CENTER SUITE 510
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3710
Mailing Address - Country:US
Mailing Address - Phone:787-765-4900
Mailing Address - Fax:
Practice Address - Street 1:400 AVE DOMENECH
Practice Address - Street 2:LAS AMERICAS PROFESSIONAL CENTER SUITE 510
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3710
Practice Address - Country:US
Practice Address - Phone:787-765-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8520207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR378520OtherUIA
PR9080033OtherHUMANA HEALTH PLAN
PR3592OtherFIRST MEDICAL
PRPE2656OtherPALIC PROVIDER
PR17645OtherPROSSAM
PR9080033OtherHUMANA INSURANCE
PR209118OtherPREFERRED HEALTH
PR80411OtherTRIPLE S
PR067407OtherCRUZ AZUL DE PR
PR209118OtherPREFERRED HEALTH
PR0080411Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER