Provider Demographics
NPI:1124093125
Name:MARTINEZ ORTIZ, MANOLO (MD)
Entity type:Individual
Prefix:DR
First Name:MANOLO
Middle Name:
Last Name:MARTINEZ ORTIZ
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:PO BOX 4166
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-4166
Mailing Address - Country:US
Mailing Address - Phone:787-726-5561
Mailing Address - Fax:
Practice Address - Street 1:106C CALLE TAPIA
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00911-2307
Practice Address - Country:US
Practice Address - Phone:787-726-5561
Practice Address - Fax:787-726-5561
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8217208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
29355OtherTRIPLE S
29355Medicare ID - Type Unspecified