Provider Demographics
NPI:1831397983
Name:I RICARDO MARTINEZ MD PHD APMC
Entity type:Organization
Organization Name:I RICARDO MARTINEZ MD PHD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:I. RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:504-309-4211
Mailing Address - Street 1:4224 HOUMA BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2933
Mailing Address - Country:US
Mailing Address - Phone:504-309-4211
Mailing Address - Fax:504-309-4214
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2933
Practice Address - Country:US
Practice Address - Phone:504-309-4211
Practice Address - Fax:504-309-4214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL010027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAD84431Medicare UPIN
LA5CE05Medicare PIN