Healthcare Provider Details

I. General information

NPI: 1548570617
Provider Name (Legal Business Name): BRENDA NOEMI MARTINEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE ER PHYSICIANS
LUBBOCK TX
79415
US

IV. Provider business mailing address

PO BOX 5980
LUBBOCK TX
79408-5980
US

V. Phone/Fax

Practice location:
  • Phone: 806-775-9700
  • Fax:
Mailing address:
  • Phone: 806-761-0878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP7501
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: