Provider Demographics
NPI:1497134415
Name:MARTINEZ, DANIEL (HIS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 GATEWAY BLVD E
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2023
Mailing Address - Country:US
Mailing Address - Phone:915-303-9200
Mailing Address - Fax:915-303-9202
Practice Address - Street 1:6044 GATEWAY BLVD E
Practice Address - Street 2:SUITE 301
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2023
Practice Address - Country:US
Practice Address - Phone:915-303-9200
Practice Address - Fax:915-303-9202
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50394237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist