Provider Demographics
NPI:1447228838
Name:MARTINEZ-MANGUAL, GINES A (MD)
Entity Type:Individual
Prefix:
First Name:GINES
Middle Name:A
Last Name:MARTINEZ-MANGUAL
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:PO BOX 6569
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6569
Mailing Address - Country:US
Mailing Address - Phone:787-744-6590
Mailing Address - Fax:787-961-4686
Practice Address - Street 1:500 AVE DEGETAU STE 405
Practice Address - Street 2:HIMA PLAZA 1
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7306
Practice Address - Country:US
Practice Address - Phone:787-744-6590
Practice Address - Fax:787-961-4686
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8842207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D95880Medicare UPIN
84536AMedicare ID - Type Unspecified