Provider Demographics
NPI:1780688218
Name:MARTINEZ, XAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:XAVIER
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1701 W. ST. MARY'S ROAD
Mailing Address - Street 2:SUITE 151
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2683
Mailing Address - Country:US
Mailing Address - Phone:520-622-7706
Mailing Address - Fax:520-622-4901
Practice Address - Street 1:1701 W. ST. MARY'S ROAD
Practice Address - Street 2:SUITE 151
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2683
Practice Address - Country:US
Practice Address - Phone:520-622-7706
Practice Address - Fax:520-622-4901
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-06-10
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
AZ18944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ18944OtherSTATE LICENSE
AZF27734Medicare UPIN