Provider Demographics
NPI:1831132273
Name:MARTINEZ, CERVANDO JR (MD)
Entity Type:Individual
Prefix:MR
First Name:CERVANDO
Middle Name:
Last Name:MARTINEZ
Suffix:JR
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 1:7526 LOUIS PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4001
Mailing Address - Country:US
Mailing Address - Phone:210-450-6440
Mailing Address - Fax:210-450-2104
Practice Address - Street 1:7526 LOUIS PASTEUR DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4001
Practice Address - Country:US
Practice Address - Phone:210-450-6440
Practice Address - Fax:210-450-2104
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD92282084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102510805OtherCSHCN
TX102510804Medicaid
TX102510803Medicaid