Provider Demographics
NPI:1346424264
Name:MARTINEZ UGARTE, MARIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:L
Last Name:MARTINEZ UGARTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:L
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:720 PLEASANTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1343
Mailing Address - Country:US
Mailing Address - Phone:210-921-3800
Mailing Address - Fax:210-334-2851
Practice Address - Street 1:730 PLEASANTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214
Practice Address - Country:US
Practice Address - Phone:210-921-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55709208C00000X
MN106302208C00000X
TXR7813208600000X, 208C00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX397530201Medicaid
MN280000160Medicare PIN