Healthcare Provider Details

I. General information

NPI: 1861021438
Provider Name (Legal Business Name): RAQUEL MARTINEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 SEVEN HILLS DR STE 203
HENDERSON NV
89052-4379
US

IV. Provider business mailing address

870 SEVEN HILLS DR
HENDERSON NV
89052-4377
US

V. Phone/Fax

Practice location:
  • Phone: 702-963-2873
  • Fax: 702-566-4575
Mailing address:
  • Phone: 702-463-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RAQUEL MARTINEZ
Title or Position: PHYSICIAN'S ASSISTANT
Credential: PA
Phone: 702-463-4788