Provider Demographics
NPI:1245777846
Name:MARTINEZ7668, CRISTINA (OTA)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:
Last Name:MARTINEZ7668
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:CRISTINA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:7668 S SWIFT RD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-9378
Mailing Address - Country:US
Mailing Address - Phone:615-389-0723
Mailing Address - Fax:
Practice Address - Street 1:7668 S SWIFT RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-9378
Practice Address - Country:US
Practice Address - Phone:615-389-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-21
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2129174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist