Provider Demographics
NPI:1801398235
Name:MARTINEZ, HENRY (NP)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 WONDER WORLD DR
Mailing Address - Street 2:ATTN: MANAGED CARE
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666
Mailing Address - Country:US
Mailing Address - Phone:512-753-3669
Mailing Address - Fax:512-753-3689
Practice Address - Street 1:1340 WONDER WORLD DR STE 4301
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7695
Practice Address - Country:US
Practice Address - Phone:512-353-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX386463901Medicaid
TXAP136638OtherADVANCED PRACTICE NURSING LICENSE
680592OtherMEDICARE
P02144918OtherRR MEDICARE