Provider Demographics
NPI:1598731382
Name:MARTINEZ, DEANNE VILLARREAL (PA)
Entity Type:Individual
Prefix:MRS
First Name:DEANNE
Middle Name:VILLARREAL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:DEANNE
Other - Middle Name:
Other - Last Name:VILLARREAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:221 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:JBSA RANDOLPH
Mailing Address - State:TX
Mailing Address - Zip Code:78150-4800
Mailing Address - Country:US
Mailing Address - Phone:210-652-0304
Mailing Address - Fax:210-292-4458
Practice Address - Street 1:221 3RD ST W BLDG 1040
Practice Address - Street 2:
Practice Address - City:JBSA RANDOLPH
Practice Address - State:TX
Practice Address - Zip Code:78150-4800
Practice Address - Country:US
Practice Address - Phone:210-652-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P57528Medicare UPIN