Healthcare Provider Details

I. General information

NPI: 1821684184
Provider Name (Legal Business Name): ALEJANDRO MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 FRANKLIN ST STE 1
WATERBURY CT
06706-1281
US

IV. Provider business mailing address

83 MAIN ST APT 8C
NEWINGTON CT
06111-1325
US

V. Phone/Fax

Practice location:
  • Phone: 203-609-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number135304
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: