Provider Demographics
NPI:1952321150
Name:MARTINEZ-ANDUJO, BENJAMIN (NP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MARTINEZ-ANDUJO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 559
Mailing Address - Street 2:
Mailing Address - City:KEENESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80643-0559
Mailing Address - Country:US
Mailing Address - Phone:303-732-4268
Mailing Address - Fax:303-732-9288
Practice Address - Street 1:190 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:KEENESBURG
Practice Address - State:CO
Practice Address - Zip Code:80643-0559
Practice Address - Country:US
Practice Address - Phone:303-732-4268
Practice Address - Fax:303-732-9288
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO108936363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily