Provider Demographics
NPI:1801143979
Name:EDWARDS, MARTHINA IFEYINWA (SA-C)
Entity type:Individual
Prefix:
First Name:MARTHINA
Middle Name:IFEYINWA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 CENTRE PKWY
Mailing Address - Street 2:530
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8271
Mailing Address - Country:US
Mailing Address - Phone:713-777-4539
Mailing Address - Fax:713-583-2061
Practice Address - Street 1:9800 CENTRE PKWY
Practice Address - Street 2:530
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8271
Practice Address - Country:US
Practice Address - Phone:713-777-4539
Practice Address - Fax:713-583-2061
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12-107246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant