Provider Demographics
NPI:1720868847
Name:ORENCIA, RONALD MARTINEZ (APRN)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:MARTINEZ
Last Name:ORENCIA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MURLYN RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2315
Mailing Address - Country:US
Mailing Address - Phone:203-772-9104
Mailing Address - Fax:
Practice Address - Street 1:915 ELLA T GRASSO BLVD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-5516
Practice Address - Country:US
Practice Address - Phone:203-349-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12466363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health