Provider Demographics
NPI:1609640507
Name:MARTINEZ, RICARDO ERNESTO (LMT)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:ERNESTO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 WOODFIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5713
Mailing Address - Country:US
Mailing Address - Phone:713-409-5469
Mailing Address - Fax:
Practice Address - Street 1:2743 SMITH RANCH RD UNIT 1304
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5219
Practice Address - Country:US
Practice Address - Phone:713-409-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT108658225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist