Provider Demographics
NPI:1275925018
Name:MARTINEZ, JORDAN LEE (DO)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEE
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2350 W HORIZON RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5075
Mailing Address - Country:US
Mailing Address - Phone:702-564-8556
Mailing Address - Fax:702-564-4485
Practice Address - Street 1:6980 S CIMARRON RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2185
Practice Address - Country:US
Practice Address - Phone:702-564-8556
Practice Address - Fax:702-564-4485
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO2800208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics