Provider Demographics
NPI:1457097297
Name:MARTINEZ, BALDEMAR JR
Entity Type:Individual
Prefix:
First Name:BALDEMAR
Middle Name:
Last Name:MARTINEZ
Suffix:JR
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 1:13401 METRIC BLVD APT UNIT0114
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3319
Mailing Address - Country:US
Mailing Address - Phone:682-300-5574
Mailing Address - Fax:
Practice Address - Street 1:13401 METRIC BLVD APT UNIT0114
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-3319
Practice Address - Country:US
Practice Address - Phone:682-300-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist