Provider Demographics
NPI:1912913658
Name:MARTINEZ, CARLA A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 RAYNOLDS ST # 51015
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-1613
Mailing Address - Country:US
Mailing Address - Phone:915-215-4480
Mailing Address - Fax:915-215-5386
Practice Address - Street 1:4801 ALBERTA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2707
Practice Address - Country:US
Practice Address - Phone:915-215-5000
Practice Address - Fax:915-215-8662
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0852207V00000X, 207VM0101X
TXM3635207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM267233YNB8OtherNEW MEXICO MEDICARE PTN
TX183331101Medicaid
TX8A4439OtherBCBSTX
NM8G7647OtherMEDICARE ID TYPE UNSPEC
NM02855879Medicaid
TX8A4439OtherBCBSTX
NM267233YNB8OtherNEW MEXICO MEDICARE PTN