Healthcare Provider Details

I. General information

NPI: 1740116805
Provider Name (Legal Business Name): CARLOS MARTINEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 1ST AVE N APT 414
GRAND FORKS ND
58203-3640
US

IV. Provider business mailing address

615 1ST AVE N APT 414
GRAND FORKS ND
58203-3640
US

V. Phone/Fax

Practice location:
  • Phone: 701-330-0372
  • Fax:
Mailing address:
  • Phone: 701-330-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: