Healthcare Provider Details

I. General information

NPI: 1649987975
Provider Name (Legal Business Name): ILEANA LIZETH MARTINEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108A N MAIN ST
DAYTON TX
77535-2642
US

IV. Provider business mailing address

2255 E MOSSY OAKS RD STE 500
SPRING TX
77389-1813
US

V. Phone/Fax

Practice location:
  • Phone: 281-440-5300
  • Fax:
Mailing address:
  • Phone: 832-597-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number946931
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1110885
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: