Provider Demographics
NPI:1760474092
Name:MARTINEZ RIOS, GUILLERMO EMILIO (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:EMILIO
Last Name:MARTINEZ RIOS
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:EDIFICIO MEDICO HERMANAS DAVILA
Mailing Address - Street 2:16 CALLE B STE 105
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5041
Mailing Address - Country:US
Mailing Address - Phone:787-740-0120
Mailing Address - Fax:787-785-7787
Practice Address - Street 1:EDIFICIO MEDICO HERMANAS DAVILA
Practice Address - Street 2:16 CALLE B STE 105
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5041
Practice Address - Country:US
Practice Address - Phone:787-740-0120
Practice Address - Fax:787-785-7787
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8265207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29485Medicaid
PR0029485OtherPTAN
PRD08519Medicare UPIN