Provider Demographics
NPI:1295983310
Name:MARTINEZ, CONRADO (PA-C)
Entity type:Individual
Prefix:MR
First Name:CONRADO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 E DANENBERG DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-8517
Mailing Address - Country:US
Mailing Address - Phone:760-344-9951
Mailing Address - Fax:760-344-5840
Practice Address - Street 1:223 W COLE BLVD
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-9722
Practice Address - Country:US
Practice Address - Phone:760-357-2020
Practice Address - Fax:760-357-1056
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 19858OtherP.A. LICENSE #PA 19858