Provider Demographics
NPI:1760243752
Name:MARTINEZ RODRIGUEZ, JORGE LUIS SR
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:MARTINEZ RODRIGUEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 S ANZA ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6602
Mailing Address - Country:US
Mailing Address - Phone:619-442-0544
Mailing Address - Fax:
Practice Address - Street 1:622 S ANZA ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6602
Practice Address - Country:US
Practice Address - Phone:619-422-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95325556163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty