Provider Demographics
NPI:1609381318
Name:MARTINEZ, BENANCIO JR (NP-C)
Entity Type:Individual
Prefix:MR
First Name:BENANCIO
Middle Name:
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 BIRCH VILLA DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1135
Mailing Address - Country:US
Mailing Address - Phone:832-274-8192
Mailing Address - Fax:
Practice Address - Street 1:9190 KATY FWY STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7440
Practice Address - Country:US
Practice Address - Phone:832-358-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily