Provider Demographics
NPI:1407895451
Name:GLORIA L MARTIN MD LTD
Entity Type:Organization
Organization Name:GLORIA L MARTIN MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-385-3070
Mailing Address - Street 1:1000 N GREEN VALLEY PKWY
Mailing Address - Street 2:#440-164
Mailing Address - City:HENDERON
Mailing Address - State:NV
Mailing Address - Zip Code:89074
Mailing Address - Country:US
Mailing Address - Phone:702-385-3070
Mailing Address - Fax:702-650-0548
Practice Address - Street 1:2010 GOLDRING AVE
Practice Address - Street 2:#303
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-385-3070
Practice Address - Fax:702-650-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6945207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV39017Medicare ID - Type Unspecified