Provider Demographics
NPI:1770810673
Name:MARTINEZ, LILLIAN SUSAN (CNA,HHA,AAS,CPR)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:SUSAN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CNA,HHA,AAS,CPR
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 128
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-0128
Mailing Address - Country:US
Mailing Address - Phone:830-538-9464
Mailing Address - Fax:
Practice Address - Street 1:1616 ANGELO ST
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-4314
Practice Address - Country:US
Practice Address - Phone:830-538-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA10078860376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide