Provider Demographics
NPI:1922542182
Name:MARTINEZ, MARCO (FNP)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:MARCO
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:754 MEDICAL CENTER CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6654
Mailing Address - Country:US
Mailing Address - Phone:619-421-4000
Mailing Address - Fax:
Practice Address - Street 1:754 MEDICAL CENTER CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6654
Practice Address - Country:US
Practice Address - Phone:619-421-4000
Practice Address - Fax:619-421-6395
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005530164W00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No164W00000XNursing Service ProvidersLicensed Practical Nurse