Provider Demographics
NPI:1861401739
Name:MARTINEZ, MARIO A (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:A
Last Name:MARTINEZ
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 1:3829 SARATOGA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5814
Mailing Address - Country:US
Mailing Address - Phone:361-906-2121
Mailing Address - Fax:361-906-2264
Practice Address - Street 1:3829 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5814
Practice Address - Country:US
Practice Address - Phone:361-906-2121
Practice Address - Fax:361-906-2264
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM3637OtherTEXAS MEDICAL LICENSE