Healthcare Provider Details

I. General information

NPI: 1306116264
Provider Name (Legal Business Name): LYNORE MARTINEZ, MD, PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 KIVA CT
SANTA FE NM
87505-5879
US

IV. Provider business mailing address

405 KIVA CT
SANTA FE NM
87505-5879
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-4922
  • Fax:
Mailing address:
  • Phone: 505-988-4922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number95294
License Number StateNM

VIII. Authorized Official

Name: LYNORE MARTINEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-988-4922