Provider Demographics
NPI:1629700869
Name:MARTINEZ, MARCO A (PA)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 JOY ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6061
Mailing Address - Country:US
Mailing Address - Phone:956-975-8401
Mailing Address - Fax:
Practice Address - Street 1:306 E MAIN AVE STE 6
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-6955
Practice Address - Country:US
Practice Address - Phone:956-597-3005
Practice Address - Fax:855-576-4965
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17042363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical