Healthcare Provider Details

I. General information

NPI: 1750865697
Provider Name (Legal Business Name): CHRISTIN MICHELLE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 GATEWAY BLVD W
EL PASO TX
79925-7701
US

IV. Provider business mailing address

1320 HOOKRIDGE DR
EL PASO TX
79925-7829
US

V. Phone/Fax

Practice location:
  • Phone: 915-263-5000
  • Fax:
Mailing address:
  • Phone: 915-329-3483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP138659
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP138659
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: