Provider Demographics
NPI:1659369395
Name:MARTELL, GUSTAVO ARMANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ARMANDO
Last Name:MARTELL
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 1:11040 VISTA DEL SOL DR
Mailing Address - Street 2:STE. A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4314
Mailing Address - Country:US
Mailing Address - Phone:915-591-4624
Mailing Address - Fax:915-591-9291
Practice Address - Street 1:11040 VISTA DEL SOL DR
Practice Address - Street 2:STE. A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4314
Practice Address - Country:US
Practice Address - Phone:915-591-4624
Practice Address - Fax:915-591-9291
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2185207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116965801Medicaid
TXF97482Medicare UPIN
TX82X192Medicare ID - Type Unspecified