Provider Demographics
NPI:1588016869
Name:MARTINEZ, LIDIA (PA-C)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E EXPRESSWAY 83
Mailing Address - Street 2:STE 4
Mailing Address - City:LA JOYA
Mailing Address - State:TX
Mailing Address - Zip Code:78560-8302
Mailing Address - Country:US
Mailing Address - Phone:956-585-1688
Mailing Address - Fax:956-585-8008
Practice Address - Street 1:2134 E GRIFFIN PKWY
Practice Address - Street 2:STE. B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3225
Practice Address - Country:US
Practice Address - Phone:956-580-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03073OtherTMB PA