Provider Demographics
NPI:1295012128
Name:MARTINEZ, LOURDES (MAC LAC)
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 OLNEY SANDY SPRING RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1527
Mailing Address - Country:US
Mailing Address - Phone:301-774-0332
Mailing Address - Fax:301-710-0614
Practice Address - Street 1:2931 OLNEY SANDY SPRING RD
Practice Address - Street 2:SUITE F
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1527
Practice Address - Country:US
Practice Address - Phone:301-774-0332
Practice Address - Fax:301-710-0614
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01923171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist