Provider Demographics
NPI:1386680700
Name:MARTINEZ, ISAAC GERARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:GERARD
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 SAWGRASS RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7237
Mailing Address - Country:US
Mailing Address - Phone:210-373-5658
Mailing Address - Fax:210-403-9890
Practice Address - Street 1:17890 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1031
Practice Address - Country:US
Practice Address - Phone:210-373-5658
Practice Address - Fax:210-403-9890
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31001103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral