MEDICARE: CARLOS 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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1346997715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS MARTINEZ

Provider Business Mailing Address
First Line	:	7800 TEAGUE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-3154
Country	:	US
Telephone Number	:	803-476-6602
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 TEAGUE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-3154
Country	:	US
Telephone Number	:	803-476-6602
Fax Number	:

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

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/07/2022

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Directions to “ CARLOS MARTINEZ ” Practice Location

Language	Start Address	Practice Location

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