Provider Demographics
NPI:1811633951
Name:MARTINEZ, MARY ANGELIQUE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANGELIQUE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 HANSON DR
Mailing Address - Street 2:
Mailing Address - City:DOYLINE
Mailing Address - State:LA
Mailing Address - Zip Code:71023-3953
Mailing Address - Country:US
Mailing Address - Phone:318-210-1800
Mailing Address - Fax:
Practice Address - Street 1:193 HANSON DR
Practice Address - Street 2:
Practice Address - City:DOYLINE
Practice Address - State:LA
Practice Address - Zip Code:71023-3953
Practice Address - Country:US
Practice Address - Phone:318-210-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide