Provider Demographics
NPI:1134189400
Name:MARTINEZ, ROSENDO EMILIO (MD)
Entity type:Individual
Prefix:DR
First Name:ROSENDO
Middle Name:EMILIO
Last Name:MARTINEZ
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 1:2225 PONCE BY PASS SUITE 401
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1320
Mailing Address - Country:US
Mailing Address - Phone:787-840-9450
Mailing Address - Fax:787-840-9454
Practice Address - Street 1:2225 PONCE BY PASS SUITE 401
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1320
Practice Address - Country:US
Practice Address - Phone:787-840-9450
Practice Address - Fax:787-840-9454
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8781208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660438128OtherCHAMPUS CHAMPVA
PR7310095OtherHUMANA
PRSE2581OtherPALI
PR660438128OtherTRICARE
PR338781OtherUIA
PR204167OtherUTI
PR660438128OtherAARP
PR7310095OtherHUMANA
PR338781OtherUIA