Provider Demographics
NPI:1033287107
Name:MARTINEZ, JOSE ANGEL JR (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANGEL
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 SATTLER ROAD, #6
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133
Mailing Address - Country:US
Mailing Address - Phone:830-964-5575
Mailing Address - Fax:830-964-2294
Practice Address - Street 1:1395 SATTLER RD STE 6
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78132-2296
Practice Address - Country:US
Practice Address - Phone:830-964-5575
Practice Address - Fax:830-964-2294
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP01570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant