Healthcare Provider Details

I. General information

NPI: 1700243771
Provider Name (Legal Business Name): JANETH MARTINEZ INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 COPPER AVE NE
ALBUQUERQUE NM
87108-2068
US

IV. Provider business mailing address

7401 COPPER AVE NE
ALBUQUERQUE NM
87108-2068
US

V. Phone/Fax

Practice location:
  • Phone: 505-232-9803
  • Fax: 505-266-2431
Mailing address:
  • Phone: 505-232-9803
  • Fax: 505-266-2431

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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: