Healthcare Provider Details

I. General information

NPI: 1679652796
Provider Name (Legal Business Name): DEOGRACIAS RUFINO MARTINEZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DEO MARTINEZ MD

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 N TENAYA WAY
LAS VEGAS NV
89128-0424
US

IV. Provider business mailing address

PO BOX 15645
LAS VEGAS NV
89114-5645
US

V. Phone/Fax

Practice location:
  • Phone: 702-243-8500
  • Fax: 702-560-2928
Mailing address:
  • Phone: 702-243-8500
  • Fax: 702-560-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8869
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: