Provider Demographics
NPI:1700243771
Name:MARTINEZ, JANETH (INTERN)
Entity Type:Individual
Prefix:
First Name:JANETH
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 COPPER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2068
Mailing Address - Country:US
Mailing Address - Phone:505-232-9803
Mailing Address - Fax:505-266-2431
Practice Address - Street 1:7401 COPPER AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2068
Practice Address - Country:US
Practice Address - Phone:505-232-9803
Practice Address - Fax:505-266-2431
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00000000OtherINTERN