Provider Demographics
NPI:1003412818
Name:OSORIO, RAUL MARTINEZ SR
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:MARTINEZ
Last Name:OSORIO
Suffix:SR
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 1:7320 SW 82ND ST APT B201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7423
Mailing Address - Country:US
Mailing Address - Phone:305-588-0720
Mailing Address - Fax:
Practice Address - Street 1:7320 SW 82ND ST APT B201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7423
Practice Address - Country:US
Practice Address - Phone:305-588-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20-463246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant