Healthcare Provider Details

I. General information

NPI: 1740671833
Provider Name (Legal Business Name): NOHELANI MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19780 S US HIGHWAY 281
SAN ANTONIO TX
78221-9761
US

IV. Provider business mailing address

PO BOX 734812
DALLAS TX
75373-4812
US

V. Phone/Fax

Practice location:
  • Phone: 210-626-0600
  • Fax: 210-626-1174
Mailing address:
  • Phone: 210-358-9500
  • Fax: 210-358-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP126954
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: