Provider Demographics
NPI:1447394366
Name:MARTINEZ, MANUELA RAMOS (RN)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:RAMOS
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 W PARK VIEW LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-3249
Mailing Address - Country:US
Mailing Address - Phone:602-442-2405
Mailing Address - Fax:
Practice Address - Street 1:3801 W ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-1304
Practice Address - Country:US
Practice Address - Phone:602-442-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNO68517163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ623505OtherAHCCCS NUMBER