Provider Demographics
NPI:1972219731
Name:MARTINEZ, ITZEL NAYELY (PA)
Entity Type:Individual
Prefix:
First Name:ITZEL
Middle Name:NAYELY
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18665 E 54TH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8886
Mailing Address - Country:US
Mailing Address - Phone:720-382-9393
Mailing Address - Fax:
Practice Address - Street 1:1339 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-4235
Practice Address - Country:US
Practice Address - Phone:303-602-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant