Provider Demographics
NPI:1063037570
Name:MARTINEZ BRICENO, GUSTAVO (DO)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:MARTINEZ BRICENO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5722
Mailing Address - Country:US
Mailing Address - Phone:407-841-7290
Mailing Address - Fax:407-636-7800
Practice Address - Street 1:414 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5722
Practice Address - Country:US
Practice Address - Phone:407-654-6506
Practice Address - Fax:407-636-7800
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS21602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine