Provider Demographics
NPI:1598753782
Name:MARTINEZ, JULIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 LUISA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4347
Mailing Address - Country:US
Mailing Address - Phone:505-930-5040
Mailing Address - Fax:
Practice Address - Street 1:1414 LUISA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4347
Practice Address - Country:US
Practice Address - Phone:505-930-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41258207Q00000X
NMMD2007-0780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30928818Medicaid
CO840706945158OtherROCKY MOUNTAIN HEALH PLAN
70156034OtherNEW MEXICO MEDICAID
P00120116OtherTRAVELERS MEDICARE
COMA666493OtherANTHEM BCBS
COMA666493OtherANTHEM BCBS
CO840706945158OtherROCKY MOUNTAIN HEALH PLAN