Healthcare Provider Details

I. General information

NPI: 1699295188
Provider Name (Legal Business Name): JAKE CORDELL MARTINEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S DOBSON RD STE 203
MESA AZ
85202-4726
US

IV. Provider business mailing address

1520 S DOBSON RD STE 203
MESA AZ
85202-4726
US

V. Phone/Fax

Practice location:
  • Phone: 807-337-5354
  • Fax: 480-896-3374
Mailing address:
  • Phone: 807-337-5354
  • Fax: 480-896-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number12038
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: