Provider Demographics
NPI:1811467590
Name:MARTIN ACUNA, SERGIO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:MARTIN ACUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SERGIO
Other - Middle Name:
Other - Last Name:MARTIN-ACUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:37 COLLEGE AVE # 424
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1032
Mailing Address - Country:US
Mailing Address - Phone:510-458-1145
Mailing Address - Fax:
Practice Address - Street 1:37 COLLEGE AVE # 424
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1032
Practice Address - Country:US
Practice Address - Phone:510-458-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer