Provider Demographics
NPI:1518266170
Name:MARTINEZ, MARIA T (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:T
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1787
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2227
Mailing Address - Country:US
Mailing Address - Phone:360-533-4599
Mailing Address - Fax:360-537-6514
Practice Address - Street 1:615 NORTH F STREET
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520
Practice Address - Country:US
Practice Address - Phone:360-533-4599
Practice Address - Fax:360-537-6514
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAOP60524961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program