Basic Information
| Provider Information | |||||||||
| NPI: | 1811659246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | GILBERTO | ||||||||
| MiddleName: | ANGEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9811 S I-35 FRONTAGE RD | ||||||||
| Address2: | UNIT 100 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883083728 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9811 S INTERSTATE 35 BLDG 1 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787447901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883083728 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2021 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-21-186592 | TX | Y |
ID Information
| ID | Type | State | Issuer | Description | RBT-21-186592 | 01 | BACB | OTHER |