Provider Demographics
NPI:1659895365
Name:MARTINEZ, BO ANTHONY (AUD)
Entity type:Individual
Prefix:
First Name:BO
Middle Name:ANTHONY
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CALLE DE NINOS
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3298
Mailing Address - Country:US
Mailing Address - Phone:719-924-3805
Mailing Address - Fax:
Practice Address - Street 1:5505 N MESA ST STE 3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5464
Practice Address - Country:US
Practice Address - Phone:915-234-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80998231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist