Provider Demographics
NPI:1568873453
Name:MARTINEZ, MARIA ALEJANDRA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEJANDRA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11803 SOUTH FWY STE 112
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7028
Mailing Address - Country:US
Mailing Address - Phone:817-293-5547
Mailing Address - Fax:817-293-8557
Practice Address - Street 1:11803 SOUTH FWY STE 112
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7028
Practice Address - Country:US
Practice Address - Phone:817-293-5547
Practice Address - Fax:817-293-8557
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8336208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1J6194OtherMEDICARE