Provider Demographics
NPI:1316575095
Name:MARTINEZ, CLARA O
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:O
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 1:5002 WISEMAN BLVD APT 9303
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3803
Mailing Address - Country:US
Mailing Address - Phone:210-788-3869
Mailing Address - Fax:
Practice Address - Street 1:5002 WISEMAN BLVD APT 9303
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3803
Practice Address - Country:US
Practice Address - Phone:210-788-3869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301343164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse