Healthcare Provider Details

I. General information

NPI: 1194617498
Provider Name (Legal Business Name): JOHN PERFECTO MARTINEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2025
Last Update Date: 07/19/2025
Certification Date: 07/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC09 5040 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1204 COLUMBIA DR NE
ALBUQUERQUE NM
87106-2604
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-9864
  • Fax:
Mailing address:
  • Phone: 505-617-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: