Healthcare Provider Details

I. General information

NPI: 1023202132
Provider Name (Legal Business Name): FERNANDA MARTINEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W SAINT MARYS RD
TUCSON AZ
85745-2623
US

IV. Provider business mailing address

1601 W SAINT MARYS RD
TUCSON AZ
85745-2623
US

V. Phone/Fax

Practice location:
  • Phone: 520-872-4301
  • Fax:
Mailing address:
  • Phone: 520-872-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number3902
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: