Provider Demographics
NPI:1619457843
Name:MARTINEZ-BALADEJO, MARIA TATIANA
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:TATIANA
Last Name:MARTINEZ-BALADEJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1138
Mailing Address - Country:US
Mailing Address - Phone:484-658-1151
Mailing Address - Fax:484-464-4831
Practice Address - Street 1:211 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1138
Practice Address - Country:US
Practice Address - Phone:484-658-1151
Practice Address - Fax:484-464-4831
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT230720390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program