Provider Demographics
NPI:1881191831
Name:MARTINEZ, BRENDI
Entity Type:Individual
Prefix:
First Name:BRENDI
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 1:291025
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229
Mailing Address - Country:US
Mailing Address - Phone:720-641-2768
Mailing Address - Fax:
Practice Address - Street 1:10465 MELODY DRIVE
Practice Address - Street 2:
Practice Address - City:NORTHLAND
Practice Address - State:CO
Practice Address - Zip Code:80234
Practice Address - Country:US
Practice Address - Phone:720-641-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO023570034OtherDRIVER LICENSE