Provider Demographics
NPI:1518180405
Name:MARTINEZ, GERARDO (CRT,RPSGT)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CRT,RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 MCPHERSON AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5281
Mailing Address - Country:US
Mailing Address - Phone:956-725-2922
Mailing Address - Fax:956-723-2412
Practice Address - Street 1:4001 MCPHERSON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5281
Practice Address - Country:US
Practice Address - Phone:956-725-2922
Practice Address - Fax:956-723-2412
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6102246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPL7138OtherBLUE CROSS BLUE SHIELD
TX1566069-01Medicaid
TXFTSO31Medicare PIN