Provider Demographics
NPI:1003538851
Name:MARTINEZ, LUIS BENIGNO III
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:BENIGNO
Last Name:MARTINEZ
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 N HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5157
Mailing Address - Country:US
Mailing Address - Phone:985-607-4357
Mailing Address - Fax:
Practice Address - Street 1:1850 N HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5157
Practice Address - Country:US
Practice Address - Phone:985-809-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA226932363LF0000X
AZ280972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily