Healthcare Provider Details

I. General information

NPI: 1497134415
Provider Name (Legal Business Name): DANIEL MARTINEZ H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6044 GATEWAY BLVD E SUITE 301
EL PASO TX
79905-2023
US

IV. Provider business mailing address

6044 GATEWAY BLVD E SUITE 301
EL PASO TX
79905-2023
US

V. Phone/Fax

Practice location:
  • Phone: 915-303-9200
  • Fax: 915-303-9202
Mailing address:
  • Phone: 915-303-9200
  • Fax: 915-303-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number50394
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: