Provider Demographics
NPI:1417560665
Name:MARTINEZ, JOSE ALEJANDRO (LVN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N NOLAN AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-3255
Mailing Address - Country:US
Mailing Address - Phone:254-421-3979
Mailing Address - Fax:
Practice Address - Street 1:104 N NOLAN AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-3255
Practice Address - Country:US
Practice Address - Phone:254-421-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350461164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse