Provider Demographics
NPI:1083102768
Name:MARTINEZ, JOSE ANGEL JR (PA)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANGEL
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1920 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3106
Mailing Address - Country:US
Mailing Address - Phone:956-584-3353
Mailing Address - Fax:956-584-3253
Practice Address - Street 1:1920 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3106
Practice Address - Country:US
Practice Address - Phone:956-584-3353
Practice Address - Fax:956-584-3253
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPATEMPOtherPHYSICIAN ASSISTANT TEMP. LICENSE