Provider Demographics
NPI:1598283335
Name:MARTINEZ, CARLIE MORAZA (NP)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:MORAZA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:CHRISTINE
Other - Last Name:MORAZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 HARRISON AVE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTOM
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY STREET
Practice Address - Street 2:SHAPIRO 5 AND 6
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1003
Practice Address - Country:US
Practice Address - Phone:617-414-5951
Practice Address - Fax:617-414-9201
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2329868363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology