Healthcare Provider Details

I. General information

NPI: 1477882132
Provider Name (Legal Business Name): MARY LOUISE MARTIN EMT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 PITTMAN RD
SAINT HEDWIG TX
78152-3602
US

IV. Provider business mailing address

3190 PITTMAN RD
SAINT HEDWIG TX
78152-3602
US

V. Phone/Fax

Practice location:
  • Phone: 210-667-1001
  • Fax:
Mailing address:
  • Phone: 210-667-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number36210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: