Healthcare Provider Details

I. General information

NPI: 1235060567
Provider Name (Legal Business Name): IRMA CAMILA MARTINEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMILA MARTINEZ PA-C

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N MOUNTAIN RD STE 203
PLAINVILLE CT
06062-1848
US

IV. Provider business mailing address

46 OAKWOOD AVE
WEST HARTFORD CT
06119-2175
US

V. Phone/Fax

Practice location:
  • Phone: 860-827-4199
  • Fax: 860-827-4198
Mailing address:
  • Phone: 860-692-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1230515
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: