Healthcare Provider Details

I. General information

NPI: 1770465668
Provider Name (Legal Business Name): PTRICIA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JACKSON ST NE
MINNEAPOLIS MN
55413-1672
US

IV. Provider business mailing address

3328 42ND AVE SE
ROCHESTER MN
55904-6120
US

V. Phone/Fax

Practice location:
  • Phone: 612-353-6293
  • Fax:
Mailing address:
  • Phone: 507-271-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: