Provider Demographics
NPI:1609866961
Name:MARTINEZ, ALICIA (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
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:PO BOX 16455
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85211-6455
Mailing Address - Country:US
Mailing Address - Phone:480-615-2010
Mailing Address - Fax:480-962-0523
Practice Address - Street 1:3921 E BASELINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2727
Practice Address - Country:US
Practice Address - Phone:480-615-2010
Practice Address - Fax:480-545-4158
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15059208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ269705Medicaid
AZD44217Medicare UPIN