Provider Demographics
NPI:1578635140
Name:MARTINEZ, MILDRED M (NP)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5014
Mailing Address - Country:US
Mailing Address - Phone:702-357-8811
Mailing Address - Fax:702-947-5352
Practice Address - Street 1:861 CORONADO CENTER DR STE 220
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3992
Practice Address - Country:US
Practice Address - Phone:702-357-8811
Practice Address - Fax:702-947-5352
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13396363LG0600X
NVAPRN000964363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WNP13396EMedicare ID - Type Unspecified
CAQ06320Medicare UPIN