Provider Demographics
NPI:1649879859
Name:MARTINEZ, ALEXANDRIA (LAC)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:LAC
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 381
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-0381
Mailing Address - Country:US
Mailing Address - Phone:915-252-2543
Mailing Address - Fax:
Practice Address - Street 1:236 N WASHINGTON ST UNIT 3W
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7185
Practice Address - Country:US
Practice Address - Phone:719-677-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002685171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist