Provider Demographics
NPI:1952960817
Name:MARTINEZ, MARY T
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:T
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 1:585 OSUNA RD NE STE F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1084
Mailing Address - Country:US
Mailing Address - Phone:505-884-0353
Mailing Address - Fax:505-830-2547
Practice Address - Street 1:585 OSUNA RD NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1084
Practice Address - Country:US
Practice Address - Phone:505-884-0353
Practice Address - Fax:505-830-2547
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NM3644253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health