Healthcare Provider Details

I. General information

NPI: 1902796683
Provider Name (Legal Business Name): JACLYN MARTINEZ RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2025
Last Update Date: 07/05/2025
Certification Date: 07/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 COORS BLVD NW
ALBUQUERQUE NM
87120-3699
US

IV. Provider business mailing address

1308 BERNARDO CT NE
ALBUQUERQUE NM
87113-0007
US

V. Phone/Fax

Practice location:
  • Phone: 505-596-2200
  • Fax:
Mailing address:
  • Phone: 505-620-1083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRCP4010
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: