Provider Demographics
NPI:1972717239
Name:MARTINEZ TRABAL, JORGE L (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:MARTINEZ TRABAL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:604 CALLE FELIPE
Mailing Address - Street 2:MANSION REAL
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2640
Mailing Address - Country:US
Mailing Address - Phone:787-651-1429
Mailing Address - Fax:787-651-1430
Practice Address - Street 1:909 AVE TITO CASTRO
Practice Address - Street 2:TORRE MEDICA SAN LUCAS STE 602
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4728
Practice Address - Country:US
Practice Address - Phone:787-651-1429
Practice Address - Fax:787-651-1430
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2010-08-24
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Provider Licenses
StateLicense IDTaxonomies
PR142412086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028195Medicaid
PR0028195Medicare PIN