Provider Demographics
NPI:1992356612
Name:MARTINEZ, GABRIELA FRANCESCA (RPH)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:FRANCESCA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12034 LEDBURY COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-3031
Mailing Address - Country:US
Mailing Address - Phone:405-821-6748
Mailing Address - Fax:
Practice Address - Street 1:6102 S MACDILL AVE STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-4779
Practice Address - Country:US
Practice Address - Phone:813-570-7194
Practice Address - Fax:813-570-7199
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1548716061Medicaid