Provider Demographics
NPI:1417635160
Name:MARTINEZ, BALDEMAR
Entity Type:Individual
Prefix:
First Name:BALDEMAR
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 LOPEZ RD
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-6685
Mailing Address - Country:US
Mailing Address - Phone:956-257-5085
Mailing Address - Fax:
Practice Address - Street 1:3032 LOPEZ RD
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-6685
Practice Address - Country:US
Practice Address - Phone:956-257-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities