Healthcare Provider Details

I. General information

NPI: 1295983310
Provider Name (Legal Business Name): CONRADO MARTINEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 03/08/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 W COLE BLVD
CALEXICO CA
92231-9722
US

IV. Provider business mailing address

852 E DANENBERG DR
EL CENTRO CA
92243-8517
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-2020
  • Fax: 760-357-1056
Mailing address:
  • Phone: 760-344-9951
  • Fax: 760-344-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: