Provider Demographics
NPI:1861021438
Name:RAQUEL MARTINEZ
Entity Type:Organization
Organization Name:RAQUEL MARTINEZ
Other - Org Name:RAQAUEL MARTINEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN'S ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:702-463-4788
Mailing Address - Street 1:870 SEVEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4377
Mailing Address - Country:US
Mailing Address - Phone:702-463-4788
Mailing Address - Fax:
Practice Address - Street 1:870 SEVEN HILLS DR STE 203
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4379
Practice Address - Country:US
Practice Address - Phone:702-963-2873
Practice Address - Fax:702-566-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health