Provider Demographics
NPI:1861842742
Name:DENIS-MARTINEZ, MIRTA
Entity Type:Individual
Prefix:
First Name:MIRTA
Middle Name:
Last Name:DENIS-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 1:2386 CABOT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-1073
Mailing Address - Country:US
Mailing Address - Phone:734-741-3016
Mailing Address - Fax:
Practice Address - Street 1:2386 CABOT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-1073
Practice Address - Country:US
Practice Address - Phone:734-741-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other