Healthcare Provider Details

I. General information

NPI: 1881614428
Provider Name (Legal Business Name): JOSEPH MICHAEL MARTINEZ B.C.-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 COORS BLVD NW STE D
ALBUQUERQUE NM
87120-1925
US

IV. Provider business mailing address

1011 KANAGA PL NW
ALBUQUERQUE NM
87120-2976
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-7373
  • Fax: 505-890-8621
Mailing address:
  • Phone: 505-872-3798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0667
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: