Provider Demographics
NPI:1629769344
Name:MARTINEZ, ALEXA RAY
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:RAY
Last Name:MARTINEZ
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 1:221 N TOWNSHIP ROAD 87
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-8919
Mailing Address - Country:US
Mailing Address - Phone:419-672-8432
Mailing Address - Fax:
Practice Address - Street 1:221 N TOWNSHIP ROAD 87
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-8919
Practice Address - Country:US
Practice Address - Phone:419-672-8432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker