Provider Demographics
NPI:1194362418
Name:MARTINEZ, MARYAM L
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:L
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 1:12671 JERSEY CIR W # W
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-4657
Mailing Address - Country:US
Mailing Address - Phone:702-810-0234
Mailing Address - Fax:
Practice Address - Street 1:12671 JERSEY CIR W
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-4657
Practice Address - Country:US
Practice Address - Phone:702-810-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider