Healthcare Provider Details

I. General information

NPI: 1235952888
Provider Name (Legal Business Name): JULIANNE MARTINEZ LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S LEA AVE
ROSWELL NM
88203-4564
US

IV. Provider business mailing address

406 S LEA AVE
ROSWELL NM
88203-4564
US

V. Phone/Fax

Practice location:
  • Phone: 575-243-5001
  • Fax: 575-616-7006
Mailing address:
  • Phone:
  • Fax: 575-616-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number24004R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: