Healthcare Provider Details

I. General information

NPI: 1912868589
Provider Name (Legal Business Name): DANIEL MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/25/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 HOT SPRINGS BLVD
LAS VEGAS NM
87701-9549
US

IV. Provider business mailing address

806 MORA ST
LAS VEGAS NM
87701-3691
US

V. Phone/Fax

Practice location:
  • Phone: 505-454-2100
  • Fax:
Mailing address:
  • Phone: 575-519-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-1275
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: