Provider Demographics
NPI:1851810352
Name:MARTINEZ, CHRISTOLIA
Entity Type:Individual
Prefix:
First Name:CHRISTOLIA
Middle Name:
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:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-0514
Mailing Address - Country:US
Mailing Address - Phone:580-318-4608
Mailing Address - Fax:
Practice Address - Street 1:400 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-3034
Practice Address - Country:US
Practice Address - Phone:580-782-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician