Healthcare Provider Details

I. General information

NPI: 1275925018
Provider Name (Legal Business Name): JORDAN LEE MARTINEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 12/22/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6980 S CIMARRON RD STE 100
LAS VEGAS NV
89113-2185
US

IV. Provider business mailing address

2350 W HORIZON RIDGE PKWY
HENDERSON NV
89052-5075
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-8556
  • Fax: 702-564-4485
Mailing address:
  • Phone: 702-564-8556
  • Fax: 702-564-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO2800
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: