Healthcare Provider Details

I. General information

NPI: 1174921241
Provider Name (Legal Business Name): STEPHANIE MELBA MARTINEZ M.S.P.H, M.H.S, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 MIDTOWN PL STE 107
RALEIGH NC
27609-1300
US

IV. Provider business mailing address

4101 FIVE OAKS DR UNIT 14
DURHAM NC
27707-5285
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-1515
  • Fax: 919-876-5656
Mailing address:
  • Phone: 407-489-9472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001005354
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: