Provider Demographics
NPI:1134742992
Name:PUPO MARTINEZ, RAIDEL
Entity type:Individual
Prefix:
First Name:RAIDEL
Middle Name:
Last Name:PUPO MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8842 W ROBSON ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2315
Mailing Address - Country:US
Mailing Address - Phone:813-263-4399
Mailing Address - Fax:
Practice Address - Street 1:8842 W ROBSON ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2315
Practice Address - Country:US
Practice Address - Phone:813-263-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)