Healthcare Provider Details

I. General information

NPI: 1922846468
Provider Name (Legal Business Name): DAKODA PATRICE MARTINEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4386 TRAIL BOSS DR
CASTLE ROCK CO
80104-7512
US

IV. Provider business mailing address

4386 TRAIL BOSS DR
CASTLE ROCK CO
80104-7512
US

V. Phone/Fax

Practice location:
  • Phone: 303-688-8666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009743
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: