MEDICARE: JOSE ANGEL MARTINEZ JR. PA-C

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	363A00000X	Physician Assistant	P01570	TX

General Provider Information

NPI Number	:	1033287107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE ANGEL MARTINEZ JR. PA-C

Provider Business Mailing Address
First Line	:	1395 SATTLER ROAD, #6
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133
Country	:	US
Telephone Number	:	830-964-5575
Fax Number	:	830-964-2294

Provider Business Practice Location Address
First Line	:	1395 SATTLER RD STE 6
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78132-2296
Country	:	US
Telephone Number	:	830-964-5575
Fax Number	:	830-964-2294

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	04/07/2010

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