Provider Demographics
NPI:1043587314
Name:MARTINEZ, EFRAIN A (CRNA)
Entity Type:Individual
Prefix:
First Name:EFRAIN
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3610
Mailing Address - Country:US
Mailing Address - Phone:703-558-5000
Mailing Address - Fax:517-787-1027
Practice Address - Street 1:1701 N GEORGE MASON DR
Practice Address - Street 2:SUITE 2D
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3610
Practice Address - Country:US
Practice Address - Phone:703-558-5000
Practice Address - Fax:517-787-1027
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001205635367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered