Provider Demographics
NPI:1922570969
Name:MARTINEZ, REGINA CAROL
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:CAROL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:CAROL
Other - Last Name:ROVENSTINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1400 GARDINA APT 116
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-3363
Mailing Address - Country:US
Mailing Address - Phone:210-463-7398
Mailing Address - Fax:
Practice Address - Street 1:1400 GARDINA APT 116
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3363
Practice Address - Country:US
Practice Address - Phone:210-463-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0771219OtherDRIVERLICENSE