Provider Demographics
NPI:1467527085
Name:MARTINEZ, AUGUSTINE R (CBPM)
Entity Type:Individual
Prefix:MR
First Name:AUGUSTINE
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CBPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 W SPEEDWAY BLVD
Mailing Address - Street 2:4108
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-3900
Mailing Address - Country:US
Mailing Address - Phone:520-270-3933
Mailing Address - Fax:
Practice Address - Street 1:2162 W SPEEDWAY BLVD
Practice Address - Street 2:4108
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-3900
Practice Address - Country:US
Practice Address - Phone:520-270-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor