Provider Demographics
NPI:1356471353
Name:MARTINEZ-SORIA, VICTOR MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
Last Name:MARTINEZ-SORIA
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 1:6157 NW LOOP 410 STE 124
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3302
Mailing Address - Country:US
Mailing Address - Phone:210-523-1411
Mailing Address - Fax:210-523-9307
Practice Address - Street 1:6157 NW LOOP 410 STE 124
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3302
Practice Address - Country:US
Practice Address - Phone:210-523-1411
Practice Address - Fax:210-523-9307
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8J9020OtherBCBS
TX158467401Medicaid
TX158468201Medicaid
TX0016KKOtherBCBS GROUP
TX158468201Medicaid
TX0016KKOtherBCBS GROUP
TXF85390Medicare UPIN