Provider Demographics
NPI:1174193494
Name:MARTINEZ ORTIZ, LUIS ANGEL
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:MARTINEZ ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 BURRSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1002
Mailing Address - Country:US
Mailing Address - Phone:315-624-6227
Mailing Address - Fax:
Practice Address - Street 1:1714 BURRSTONE RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1002
Practice Address - Country:US
Practice Address - Phone:315-624-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program