Provider Demographics
NPI:1134226574
Name:GORROCHATEGUI - RODRIGUEZ, MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:GORROCHATEGUI - RODRIGUEZ
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:CENTRO DE ACCESOS VASCULARES
Mailing Address - Street 2:735 AVE. PONCE DE LEON, PARADA 37 1/2
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918-0000
Mailing Address - Country:US
Mailing Address - Phone:787-758-3320
Mailing Address - Fax:787-758-3358
Practice Address - Street 1:HOSPITAL AUXILIO MUTUO - 1ER PISO EDIF. SAN VICENTE
Practice Address - Street 2:735 AVE. PONCE DE LEON, PARADA 37 1/2
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-758-3320
Practice Address - Fax:787-758-3358
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG42004Medicare UPIN