Healthcare Provider Details

I. General information

NPI: 1942780283
Provider Name (Legal Business Name): RAY JOSEPH MARTEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 ACADEMY RD NE STE A
ALBUQUERQUE NM
87109-3363
US

IV. Provider business mailing address

6709 ACADEMY RD NE STE A
ALBUQUERQUE NM
87109-3363
US

V. Phone/Fax

Practice location:
  • Phone: 505-308-3145
  • Fax:
Mailing address:
  • Phone: 505-308-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8325381-4406
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number243252
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number60592
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD176790
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: