Healthcare Provider Details

I. General information

NPI: 1093347098
Provider Name (Legal Business Name): DULCE CAROLINA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 S WESTERN AVE STE 400
OKLAHOMA CITY OK
73139-1712
US

IV. Provider business mailing address

5120 N LINN AVE
OKLAHOMA CITY OK
73112-8027
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-1497
  • Fax:
Mailing address:
  • Phone: 817-226-5986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: