Provider Demographics
NPI:1427001510
Name:MARTINEZ, JOANNA GARZA (PA C)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:GARZA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:13407 EMERALD SKIES WAY
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6462
Mailing Address - Country:US
Mailing Address - Phone:915-252-9910
Mailing Address - Fax:
Practice Address - Street 1:13407 EMERALD SKIES WAY
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-6462
Practice Address - Country:US
Practice Address - Phone:915-252-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA20020032363A00000X
TXPA02576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM001020OtherBC BS OF NM
NM001020OtherBC BS OF NM
P47801Medicare UPIN