Healthcare Provider Details

I. General information

NPI: 1558655092
Provider Name (Legal Business Name): ANA LUISA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7144 ALAMEDA AVE
EL PASO TX
79915-3502
US

IV. Provider business mailing address

4849 N MESA ST STE 201
EL PASO TX
79912-5919
US

V. Phone/Fax

Practice location:
  • Phone: 915-990-8683
  • Fax: 915-444-5908
Mailing address:
  • Phone: 915-351-6600
  • Fax: 915-351-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number106703
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: