Provider Demographics
NPI:1598463564
Name:MARTINEZ, ALYSSA J
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:J
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 S M ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1556
Mailing Address - Country:US
Mailing Address - Phone:956-668-7433
Mailing Address - Fax:
Practice Address - Street 1:5412 BRAND ST STE 3
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-9464
Practice Address - Country:US
Practice Address - Phone:956-488-1818
Practice Address - Fax:956-488-1819
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305481225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist