Healthcare Provider Details

I. General information

NPI: 1063221679
Provider Name (Legal Business Name): MARIO MARTINEZ LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 STATE HIGHWAY 151
SAN ANTONIO TX
78251-1900
US

IV. Provider business mailing address

9939 STATE HIGHWAY 151
SAN ANTONIO TX
78251-1900
US

V. Phone/Fax

Practice location:
  • Phone: 210-706-7800
  • Fax:
Mailing address:
  • Phone: 210-706-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number312431
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number308194
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: