Provider Demographics
NPI:1013490150
Name:MARTINEZ, WANDA E
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 PINTOAGE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFLES
Mailing Address - State:TX
Mailing Address - Zip Code:78132
Mailing Address - Country:US
Mailing Address - Phone:210-215-1296
Mailing Address - Fax:
Practice Address - Street 1:307 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5512
Practice Address - Country:US
Practice Address - Phone:210-223-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105940225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist