Provider Demographics
NPI:1023063104
Name:MARTINEZ-RODRIGUEZ, GABRIEL (MD)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:MARTINEZ-RODRIGUEZ
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:PO BOX 34239
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00734-0239
Mailing Address - Country:US
Mailing Address - Phone:787-813-1836
Mailing Address - Fax:787-813-1836
Practice Address - Street 1:SAN CRISTOBAL ANEXO TORRE I
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-848-2100
Practice Address - Fax:787-813-1836
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11939207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42761Medicare UPIN
88881Medicare ID - Type Unspecified