Provider Demographics
NPI:1659420560
Name:MARTINEZ, HUMBERTO D (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:D
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MILLS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4169
Mailing Address - Country:US
Mailing Address - Phone:505-426-3795
Mailing Address - Fax:505-425-2653
Practice Address - Street 1:105 MILLS AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4169
Practice Address - Country:US
Practice Address - Phone:505-426-3795
Practice Address - Fax:505-368-7011
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52422208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G524220Medicaid
CAWG52422NMedicare PIN
CAWG52422KMedicare PIN
CAWG52422MMedicare PIN
CAWG52422JMedicare ID - Type Unspecified
CAA52257Medicare UPIN
CA00G524220Medicaid
CAWG52422LMedicare PIN