Provider Demographics
NPI:1386228104
Name:MARTINEZ, SUYAPA YESENIA (CFTS)
Entity Type:Individual
Prefix:
First Name:SUYAPA
Middle Name:YESENIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 CLOUD NINE CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7137
Mailing Address - Country:US
Mailing Address - Phone:919-332-9578
Mailing Address - Fax:
Practice Address - Street 1:3801 COMPUTER DR STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6506
Practice Address - Country:US
Practice Address - Phone:919-803-2541
Practice Address - Fax:919-424-7913
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFTS2069335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCFTS2069OtherABC ORTHOTICS PEDORTHICS