Provider Demographics
NPI:1700446796
Name:MARTIN, LETHA (AMP)
Entity Type:Individual
Prefix:
First Name:LETHA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:AMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 S ALMA SCHOOL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7075
Mailing Address - Country:US
Mailing Address - Phone:602-726-1262
Mailing Address - Fax:
Practice Address - Street 1:3225 S ALMA SCHOOL RD # 115
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3763
Practice Address - Country:US
Practice Address - Phone:602-726-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10544001175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath