Healthcare Provider Details

I. General information

NPI: 1861842783
Provider Name (Legal Business Name): THELMA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 SUNSET GARDENS RD SW
ALBUQUERQUE NM
87105-2848
US

IV. Provider business mailing address

1921 SUNSET GARDENS RD SW
ALBUQUERQUE NM
87105-2848
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-5768
  • Fax:
Mailing address:
  • Phone: 505-414-5768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: