Provider Demographics
NPI:1457446288
Name:MARTINEZ, YANIRA MARISOL (MD)
Entity Type:Individual
Prefix:DR
First Name:YANIRA
Middle Name:MARISOL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5460 PAREDES LINE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-9740
Mailing Address - Country:US
Mailing Address - Phone:956-554-0010
Mailing Address - Fax:956-554-3288
Practice Address - Street 1:5460 PAREDES LINE RD
Practice Address - Street 2:STE 200
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-9740
Practice Address - Country:US
Practice Address - Phone:956-554-0010
Practice Address - Fax:956-554-3288
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172176304Medicaid
TX482452YLPSOtherWELLMED PTAN