Provider Demographics
NPI:1912625112
Name:MARTINEZ, JESSALYN (RPHT)
Entity Type:Individual
Prefix:
First Name:JESSALYN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1986
Mailing Address - Country:US
Mailing Address - Phone:210-647-2709
Mailing Address - Fax:
Practice Address - Street 1:5601 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1986
Practice Address - Country:US
Practice Address - Phone:210-647-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290062183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician