Provider Demographics
NPI:1558043638
Name:MARTINEZ, GINA ESTELA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ESTELA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
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 1982
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-1982
Mailing Address - Country:US
Mailing Address - Phone:787-672-6630
Mailing Address - Fax:
Practice Address - Street 1:STREET 404, KILOMETER 0.6, BARRIO DAGUEY, ANASCO, PR
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-672-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program