Provider Demographics
NPI:1093081952
Name:MARTINEZ, DONNA R
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255A CAMINO DEL PUBELO
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004
Mailing Address - Country:US
Mailing Address - Phone:505-867-2356
Mailing Address - Fax:505-867-2357
Practice Address - Street 1:255A CAMINO DEL PUBELO
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004
Practice Address - Country:US
Practice Address - Phone:505-867-2356
Practice Address - Fax:505-867-2357
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency