Healthcare Provider Details

I. General information

NPI: 1144252131
Provider Name (Legal Business Name): MARIA MARTINEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 N 16TH ST STE 425
PHOENIX AZ
85020-4492
US

IV. Provider business mailing address

7720 N 16TH ST STE 425
PHOENIX AZ
85020-4492
US

V. Phone/Fax

Practice location:
  • Phone: 602-476-0800
  • Fax: 602-476-0801
Mailing address:
  • Phone: 602-476-0800
  • Fax: 602-476-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number27189
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number27189
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: