Provider Demographics
NPI:1811201478
Name:MARTINEZ, PETE
Entity Type:Individual
Prefix:
First Name:PETE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:LOZANO
Mailing Address - State:TX
Mailing Address - Zip Code:78568-0227
Mailing Address - Country:US
Mailing Address - Phone:956-639-8585
Mailing Address - Fax:956-289-5514
Practice Address - Street 1:26619 LINE G ROAD
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586
Practice Address - Country:US
Practice Address - Phone:956-639-8585
Practice Address - Fax:956-289-5514
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No347C00000XTransportation ServicesPrivate Vehicle