Provider Demographics
NPI:1114230117
Name:MARTINEZ, JUAN EDWARDO (CSA)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:EDWARDO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CSA
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Mailing Address - Street 1:6478 GOLDEN BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80927-4195
Mailing Address - Country:US
Mailing Address - Phone:832-444-1660
Mailing Address - Fax:888-972-4762
Practice Address - Street 1:4110 BRIARGATE PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7835
Practice Address - Country:US
Practice Address - Phone:832-444-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2021-12-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical