Healthcare Provider Details

I. General information

NPI: 1013122290
Provider Name (Legal Business Name): TAMARA ROSE MARTINEZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMARA ROSE ROMERO LMT

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 PENNSYLVANIA CIR NE
ALBUQUERQUE NM
87110-7810
US

IV. Provider business mailing address

1413 GLORIETA ST NE
ALBUQUERQUE NM
87112-4118
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-0798
  • Fax:
Mailing address:
  • Phone: 505-610-2612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberLMT 5402
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: