MEDICARE: MR. EDIN MARTINEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	9305	AZ

General Provider Information

NPI Number	:	1023211711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDIN MARTINEZ

Provider Business Mailing Address
First Line	:	5425 N 80TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-5517
Country	:	US
Telephone Number	:	623-872-9122
Fax Number	:

Provider Business Practice Location Address
First Line	:	5425 N 80TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-5517
Country	:	US
Telephone Number	:	623-872-9122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	08/07/2007

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Directions to “ MR. EDIN MARTINEZ ” Practice Location

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