MEDICARE: STEPHANIE ROSAURA MARTINEZ PA

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

General Provider Information

NPI Number	:	1932062254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ROSAURA MARTINEZ PA

Provider Business Mailing Address
First Line	:	2053 ANGEL FALLS DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-4249
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4060 N MARTIN L KING BLVD STE 101
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3213
Country	:	US
Telephone Number	:	702-381-3989
Fax Number	:

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

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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