Provider Demographics
NPI:1134284011
Name:MARTINEZ, MARTHA (RNC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 BOISE WAY
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2854
Mailing Address - Country:US
Mailing Address - Phone:956-717-0226
Mailing Address - Fax:
Practice Address - Street 1:2500 ZACATECAS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-6814
Practice Address - Country:US
Practice Address - Phone:956-718-6810
Practice Address - Fax:956-721-7405
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-48667363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C9213Medicare PIN