Provider Demographics
NPI:1417589003
Name:MARTINEZ, RAQUEL Q (PA-C)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:Q
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 AMERICAN PACIFIC DR APT 2113
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8017
Mailing Address - Country:US
Mailing Address - Phone:702-858-1357
Mailing Address - Fax:
Practice Address - Street 1:10615 JEFFREYS ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4194
Practice Address - Country:US
Practice Address - Phone:702-463-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant