Provider Demographics
NPI:1922559103
Name:RAUL AMADO MARTINEZ OLIVARES
Entity Type:Organization
Organization Name:RAUL AMADO MARTINEZ OLIVARES
Other - Org Name:MED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:AMADO
Authorized Official - Last Name:MARTINEZ OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:664-634-0006
Mailing Address - Street 1:4275 EXECUTIVE SQ
Mailing Address - Street 2:STE 200
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9123
Mailing Address - Country:US
Mailing Address - Phone:800-743-3900
Mailing Address - Fax:866-272-6924
Practice Address - Street 1:JAVIER MINA 1415 2
Practice Address - Street 2:ZONA URBANA RIO TIJUANA
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22320
Practice Address - Country:MX
Practice Address - Phone:664-634-0006
Practice Address - Fax:866-272-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ1343747282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital