Provider Demographics
NPI:1164792883
Name:MARTINEZ, NOELIA
Entity Type:Individual
Prefix:
First Name:NOELIA
Middle Name:
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:PSC 41
Mailing Address - Street 2:BOX 4365
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464
Mailing Address - Country:US
Mailing Address - Phone:01144128-472-9030
Mailing Address - Fax:
Practice Address - Street 1:PSC 41
Practice Address - Street 2:BOX 4365
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09464-4365
Practice Address - Country:US
Practice Address - Phone:01144128-472-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians