Provider Demographics
NPI:1740266063
Name:DR RONALDO MARTINEZ GARCIA HEALTH SERVICES, CSP
Entity type:Organization
Organization Name:DR RONALDO MARTINEZ GARCIA HEALTH SERVICES, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-765-0670
Mailing Address - Street 1:735 PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 706 TORRE AUXILIO MUTUO
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5029
Mailing Address - Country:US
Mailing Address - Phone:787-765-0670
Mailing Address - Fax:787-294-1512
Practice Address - Street 1:735 PONCE DE LEON AVE
Practice Address - Street 2:SUITE 706 TORRE AUXILIO MUTUO
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917-5029
Practice Address - Country:US
Practice Address - Phone:787-765-0670
Practice Address - Fax:787-294-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82628Medicare ID - Type Unspecified
F07467Medicare UPIN