Provider Demographics
NPI:1932497039
Name:MARTINEZ, ANDREA M
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2575 S CIMARRON RD
Mailing Address - Street 2:STE 104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7653
Mailing Address - Country:US
Mailing Address - Phone:702-743-0330
Mailing Address - Fax:
Practice Address - Street 1:2575 S CIMARRON RD
Practice Address - Street 2:STE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7653
Practice Address - Country:US
Practice Address - Phone:702-743-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner